Postoperative radiotherapy (RT) is recommended after breast-conserving surgery and mastectomy (with risk factors). Consideration of pros and cons, including potential side effects, demands the optimization of adjuvant RT and a risk-adapted approach. There is clear de-escalation in fractionation—hypofractionation should be considered standard. For selected low-risk situations, PBI only or even the omission of RT might be appropriate. In contrast, tendencies toward escalating RT are obvious. Preoperative RT seems attractive for patients in whom breast reconstruction is planned or for defining the tumor location more precisely with the potential of giving ablative doses. Dose escalation by a (simultaneous integrated) boost or the combination with new compounds/systemic treatments may increase antitumor efficacy but also toxicity. Despite low evidence, RT for oligometastatic disease is becoming increasingly popular. The omission of axillary dissection in node-positive disease led to an escalation of regional RT. Studies are ongoing to test if any axillary treatment can be omitted and which oligometastatic patients do really benefit from RT. Besides technical improvements, the incorporation of molecular risk profiles and also the response to neoadjuvant systemic therapy have the potential to optimize the decision-making concerning if and how local and/or regional RT should be administered.
保乳手术及乳房切除术（伴危险因素）后建议行术后放疗。权衡利弊（包括潜在副作用）需优化辅助放疗方案并采取风险适应性策略。分割方案已明确降级——大分割放疗应被视为标准。对于特定低危情况，仅行部分乳腺照射甚至省略放疗可能是适宜的。相反，放疗升级趋势亦日趋明显。对于计划行乳房重建或需精确定位肿瘤位置（可能实施消融剂量）的患者，术前放疗具有吸引力。通过（同步整合）推量或联合新型化合物/系统治疗进行剂量升级可能增强抗肿瘤疗效，但亦会增加毒性。尽管证据有限，寡转移疾病的放疗应用日益广泛。淋巴结阳性疾病中腋窝清扫术的省略导致区域放疗的升级。目前正在进行研究以验证是否可省略任何腋窝治疗，以及哪些寡转移患者真正能从放疗中获益。除技术进步外，分子风险谱的整合及新辅助系统治疗的应答情况，均有望优化关于是否及如何实施局部和/或区域放疗的决策。
肿瘤(癌症)患者之家