Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid, Spain.
Department of Radiation Oncology, Hospital La Luz, Madrid, Spain.
Breast Dis. 2021;40(1):1-16. doi: 10.3233/BD-201022.
Breast cancer is the most common cancer in women worldwide and encompasses a broad spectrum of diseases in one with significant epidemiological, clinical, and biological heterogeneity, which determines a different natural history and prognostic profile. Although classical tumour staging (TNM) still provides valuable information, the current reality is that the clinicians must consider other biological and molecular factors that directly influence treatment decision-making. The management of breast cancer has changed radically in the last 15 years due to significant advances in our understanding of these tumours. This knowledge has brought with it a major impact regarding surgical and systemic management and has been practice-changing, but it has also created significant uncertainties regarding how best integrate the radiotherapy treatment into the therapeutic scheme. In parallel, radiotherapy itself has also experienced major advances, new radiobiological concepts have emerged, and genomic data and other patient-specific factors must now be integrated into individualised treatment approaches. In this context, "precision medicine" seeks to provide an answer to these open questions and uncertainties. The aim of the present review is to clarify the meaning of this term and to critically evaluate its role and impact on contemporary breast cancer radiotherapy.
乳腺癌是全球女性最常见的癌症，涵盖了一类具有显著流行病学、临床和生物学异质性的广泛疾病，这决定了不同的自然病史和预后特征。尽管经典的肿瘤分期（TNM）仍然提供了有价值的信息，但目前的现实情况是，临床医生必须考虑其他直接影响治疗决策的生物学和分子因素。由于我们对这些肿瘤的理解有了重大进展，乳腺癌的治疗在过去 15 年中发生了根本性的变化。这些知识对手术和系统治疗产生了重大影响，并改变了实践，但也对如何将放疗治疗最佳整合到治疗方案中产生了重大的不确定性。与此同时，放疗本身也取得了重大进展，出现了新的放射生物学概念，现在必须将基因组数据和其他患者特定因素纳入个体化治疗方法中。在此背景下，“精准医学”试图为这些开放性问题和不确定性提供答案。本综述的目的是阐明这个术语的含义，并批判性地评估其在当代乳腺癌放疗中的作用和影响。
