Is breast-conserving therapy adequate in BRCA 1/2 mutation carriers? Theradiation oncologist’s point of view

摘要

Breast conserving therapy (BCT) is currently a recognized alternative to mastectomy forearly BC patients. However, the therapeutic index of BCT was considered controversial fordecades in BRCA1/2 mutation carriers. The aim of the present review was to investigate theoutcome of mutation carriers undergoing BCT regarding local and distant endpoints. A shortreview was performed from the point of view of the radiation oncologist. Onlyretrospective data were available regarding local outcome assessment. They generatedconflicting results. In studies with limited follow-up, BCT did not increase the risk oflocal recurrence in BRCA1/2 mutation carriers non-carriers.Conversely, some studies with longer follow-up supported that local relapse was increasedin mutation carriers. Yet, according to some publications, their long-term risk ofipsilateral recurrence post-BCT was not different from general population cohorts.Besides, overall and metastasis-free survivals were the same after BCT regardless of theBRCA1/2 mutation status. Similar survival rates were also reported when BCT and mastectomywere compared in mutation carriers. Regarding acute or late toxicity, normal rates werereported in BRCA mutation carriers after breast radiotherapy. The BRCA1/2 mutation doesnot seem to widely alter the therapeutic index (efficacy/toxicity ratio) of modernadjuvant breast irradiation. Although the long term equivalence of BCT/mastectomy on localcontrol is still not clearly recognised, BCT can be considered an adequate option forBRCA1/2 mutation carriers. This review highlights that BCT is a reasonable option forBRCA1/2 mutation carriers however litterature is controversial concerning long-term localoutcome and results of a large prospective cohort are needed.