Title: Advanced Breast Cancer Treatment: Neo-adjuvant Radiation and Ultra-Hyperfractionated Therapy

Advanced Breast Cancer Treatment: Neo-adjuvant Radiation and Ultra-Hyperfractionated Therapy

In recent years, advanced breast cancer treatment has seen significant progress with the implementation of neo-adjuvant radiation and ultra-hyperfractionated therapy. In this text, we will discuss the current state of research on these innovative treatments.

Classification of Patients and Low-Risk Breast Cancer

Patients with breast cancer are classified into low, intermediate, and high risk based on their response to treatment. Those at a low risk have undergone complete pathological response post-treatment. Trials are ongoing to determine if nodes can be radiated or not in such cases.

Neo-adjuvant Radiation: Manipulating Immune Responses

Ionizing radiation causes double strand DNA breaks and affects the immunogenicity of the radiated tumor, creating immune responses. Trials are examining ways to manipulate these reactions for improved therapeutic responses in triple negative breast cancer.

Single-Dose Neo-adjuvant Radiation Trials

Early stage breast cancer trials using single dose radiation with stereotactic body radiation or cyber knife have shown promise but are still in their early stages. For example, the SPORT trial looked at giving a single fraction of pre-operative partial radiation to women over 60 and found no significant difference in pathological complete response or lymphocyte enrichment but reported no recurrences up to 11 months.

Future Directions: Biomarkers and Immunotherapy

Phase one trials are exploring the use of specific biomarkers and immunotherapy in combination with neo-adjuvant therapy for triple negative breast cancer. These trials look at local control rates as well as distant metastases.

Post-Brisk Conservation Surgery

Radiation post-brisk conservation surgery has been established, but the standard conventional whole-brisk radiation is no longer recommended. Ultra-hyperfractionated therapy and partial brisk irradiation are considered but have strict inclusion criteria.

Interoperative Therapy and Omitting Radiation

Interoperative therapy is not recommended outside of prospective studies, and the omission of radiation in early stage cancers based on the Lumina trial can be considered for T1 patients, elderly patients, and Luminal A patients who are willing to take endocrine therapy and follow-up closely.

Multidisciplinary Approach

The COVID-19 pandemic has highlighted the importance of a multidisciplinary team for discussing oncological outcomes and goals, as well as considering various systemic therapies and surgical techniques for optimal patient care.

In conclusion, neo-adjuvant radiation and ultra-hyperfractionated therapy are promising avenues for advanced breast cancer treatment. Research is ongoing to determine the best application of these treatments, including the role of biomarkers, immunotherapy, and patient selection.