AIRO Breast Cancer Group Best Clinical Practice 2022 Update
Authors: Ciabattoni Antonella , Gregucci Fabiana , De Rose Fiorenza , Falivene Sara , Fozza Alessandra , Daidone Antonio , Morra Anna , Smaniotto Daniela , Barbara Raffaele , Lozza Laura , Vidali Cristiana , Borghesi Simona , Palumbo Isabella , Huscher Alessandra , Perrucci Elisabetta , Baldissera Antonella , Tolento Giorgio , Rovea Paolo , Franco Pierfrancesco , De Santis Maria Carmen , Grazia Alfio Di , Marino Lorenza , Meduri Bruno , Cucciarelli Francesca , Aristei Cynthia , Bertoni Filippo , Guenzi Marina , Leonardi Maria Cristina , Livi Lorenzo , Nardone Luigia , De Felice Francesca , Rosetto Maria Elena , Mazzuoli Lidia , Anselmo Paola , Arcidiacono Fabio , Barbarino Rosaria , Martinetti Mariateresa , Pasinetti Nadia , Desideri Isacco , Marazzi Fabio , Ivaldi Giovanni , Bonzano Elisabetta , Cavallari Monica , Cerreta Vincenzo , Fusco Vincenzo , Sarno Laura , Bonanni Alessio , Mangiacotti Maria Grazia , Prisco Agnese , Buonfrate Giovanna , Andrulli Damiana , Fontana Antonella , Bagnoli Rita , Marinelli Luca , Reverberi Chiara , Scalabrino Giovanna , Corazzi Francesca , Doino Daniela , Di Genesio-Pagliuca Milena , Lazzari Mariagrazia , Mascioni Francesca , Pace Maria Paola , Mazza Mirko , Vitucci Pasquale , Spera Antonio , Macchia Gabriella , Boccardi Mariangela , Evangelista Giovanna , Sola Barbara , La Porta Maria Rosa , Fiorentino Alba , Levra Niccolò Giaj , Ippolito Edy , Silipigni Sonia , Osti Mattia Falchetto , Mignogna Marcello , Alessandro Marina , Ursini Lucia Anna , Nuzzo Marianna , Meattini Icro , D’Ermo Giuseppe 
Published: July 2022

Introduction: Breast cancer is the most common tumor in women and represents the leading cause of cancer death. Radiation therapy plays a key-role in the treatment of all breast cancer stages. Therefore, the adoption of evidence-based treatments is warranted, to ensure equity of access and standardization of care in clinical practice. Method: This national document on the highest evidence-based available data was developed and endorsed by the Italian Association of Radiation and Clinical Oncology (AIRO) Breast Cancer Group. We analyzed literature data regarding breast radiation therapy, using the SIGN (Scottish Intercollegiate Guidelines Network) methodology ( www.sign.ac.uk ). Updated findings from the literature were examined, including the highest levels of evidence (meta-analyses, randomized trials, and international guidelines) with a significant impact on clinical practice. The document deals with the role of radiation therapy in the treatment of primary breast cancer, local relapse, and metastatic disease, with focus on diagnosis, staging, local and systemic therapies, and follow up. Information is given on indications, techniques, total doses, and fractionations. Results: An extensive literature review from 2013 to 2021 was performed. The work was organized according to a general index of different topics and most chapters included individual questions and, when possible, synoptic and summary tables. Indications for radiation therapy in breast cancer were examined and integrated with other oncological treatments. A total of 50 questions were analyzed and answered. Four large areas of interest were investigated: (1) general strategy (multidisciplinary approach, contraindications, preliminary assessments, staging and management of patients with electronic devices); (2) systemic therapy (primary, adjuvant, in metastatic setting); (3) clinical aspects (invasive, non-invasive and micro-invasive carcinoma; particular situations such as young and elderly patients, breast cancer in males and cancer during pregnancy; follow up with possible acute and late toxicities; loco-regional relapse and metastatic disease); (4) technical aspects (radiation after conservative surgery or mastectomy, indications for boost, lymph node radiotherapy and partial breast irradiation). Appendixes about tumor bed boost and breast and lymph nodes contouring were implemented, including a dedicated web application. The scientific work was reviewed and validated by an expert group of breast cancer key-opinion leaders. Conclusions: Optimal breast cancer management requires a multidisciplinary approach sharing therapeutic strategies with the other involved specialists and the patient, within a coordinated and dedicated clinical path. In recent years, the high-level quality radiation therapy has shown a significant impact on local control and survival of breast cancer patients. Therefore, it is necessary to offer and guarantee accurate treatments according to the best standards of evidence-based medicine.