Résumé
The present white paper, referring to the 4th Assisi Think Tank Meeting on breast cancer, reviews state-of-the-art data, on-going studies and research proposals. <70% agreement in an online questionnaire identified the following clinical challenges: 1: Nodal RT in patients who have a) 1–2 positive sentinel nodes without ALND (axillary lymph node dissection); b) cN1 disease transformed into ypN0 by primary systemic therapy and c) 1–3 positive nodes after mastectomy and ALND. 2. The optimal combination of RT and immunotherapy (IT), patient selection, IT-RT timing, and RT optimal dose, fractionation and target volume. Most experts agreed that RT- IT combination does not enhance toxicity. 3: Re-irradiation for local relapse converged on the use of partial breast irradiation after second breast conserving surgery. Hyperthermia aroused support but is not widely available. Further studies are required to finetune best practice, especially given the increasing use of re-irradiation.
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•Undefined nodal RT indications for non-ALND patients with 1–2 positive SLN.•Undefined nodal RT indications when PST transforms cN1 disease into ypN0.•Undefined nodal RT indications for N + 1–3 mastectomized patients.•Optimal combinations of RT and immunotherapy are as yet unknown.•PBI after second BCS should be proposed for re-irradiation in low-risk patients.•Hyperthermia should be made available for superficial breast cancer recurrencesrecurrences.