Omission of Radiation Therapy (RT) for Metaplastic Breast Cancer (MBC): A Review Article
Omer Sager, Ferrat Dinçoğlan, Selçuk Demiral, Bora Uysal, Hakan Gamsız, Onurhan Çolak, Fatih Özcan, Bahar Dırıcan, Murat Beyzadeoğlu
Abstract
Background: Metaplastic breast c ancer (MBC) is a unique pathological entity characterized by histologic presence of 2 or more cellular types frequently representing mixed epithelial and mesenchymal components. Although comprising a small proportion of all breast cancers, MBC may have a distinct clinical behavior typically with an aggressive disease course in affected patients. Optimal therapeutic strategies for management of MBC have yet to be defined. Extrapolation of evidence for management of frequent types of breast cancer such as invasive ductal carcinoma has been considered, however, MBC may require thorough and more intensive management with its distinctive features given the poorer prognosis and aggressive disease course. Radiation therapy (RT) has a critical role in management of breast cancer with several studies addressing its utility for achieving improved therapeutic outcomes. However, adverse effects of irradiation has been an important concern with improved survival of patients due to more effective therapies. Radiation induced toxicity such as pneumonitis, cardiac morbidities, secondary cancers along with impaired cosmesis may lead to severe consequences although modernized RT techniques and equipment hold promise. Quality of life has been a critical aspect of contemporary management strategies, and sparing of selected patients from adverse effects of irradiation has been considered. Omission of postoperative RT for selected early stage breast cancer patients has been suggested in several studies, however, there is paucity of data on patients with MBC.