Modern radiotherapy for breast cancer: Update and new developments

Abstract The delivery of radiotherapy for breast cancer has evolved significantly over the years. The aim of this review is to highlight important developments and current concepts. Postoperative hypofractionated three-dimensional conformal or intensity-modulated photon radiotherapy continues to be the standard application after breast-conserving surgery to improve local control. New therapy techniques in deep inspiration breath hold or physical-biological advantages of proton beam therapy offer innovative therapy methods with regard to the protection of normal tissue and reduced cardiotoxicity. Ultra-hypofractionated therapy concepts and the integration of a simultaneous integrated boost in hypofractionated therapy concepts also enable the duration of treatment to be reduced to a few days or weeks. In low-risk constellations, the radiation volume may also be de-escalated to partial breast irradiation, and if life expectancy is severely restricted at the same time, the omission of postoperative radiotherapy might be critically discussed. The oncological benefit of an irradiation of the regional lymph node regions continues to be confirmed in locally advanced, node-positive carcinomas and further enables the omission of surgical axillary lymph node dissection with low morbidity in individualized therapy approaches.