Reshaping Breast Cancer Survivorship Through Expanding the Indications for the Omission of Radiation

Abstract Purpose of Review As greater emphasis is placed on survivorship and long-term morbidity, more attention is being paid to de-escalation. This review examines areas where radiation may be safely omitted without compromising outcomes, thereby improving quality of life for breast cancer survivors. Recent Findings Prospective randomized trials have identified populations that may safely avoid radiation after lumpectomy, although in many cases this may be a choice between radiation or anti-estrogen therapy. There is also retrospective and emerging prospective data identifying subsets of node positive patients undergoing mastectomy for whom radiation can be omitted, including low-risk patients and patients with complete responses to neoadjuvant therapy. Summary Several retrospective and prospective studies have demonstrated that for subsets of patients, often based on newer prognostic assays, radiation may be safely omitted. This often involves shared decision making with the patient in a multidisciplinary fashion, as de-escalation of one modality is often predicated on the receipt of others.