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September 24, 2020

Trends in Deescalation of Localized Breast Cancer Treatment and Caution for the Most Vulnerable Patients—A Look Back on the Decade That Was

Author Affiliations
  • 1Harvard Radiation Oncology Program, Boston, Massachusetts
  • 2Department of Radiation Oncology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
  • 3Section of Hematology and Medical Oncology, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
JAMA Oncol. Published online September 24, 2020. doi:10.1001/jamaoncol.2020.1821

The management of localized breast cancer often involves a trimodality approach of surgery and radiation therapy with or without systemic treatment. During this past decade, substantial advances were made to minimize aggressive and radical surgery, reduce radiation-related toxicity, and use precision medicine to forego systemic chemotherapy in select estrogen receptor–positive patients. In the era of targeted therapies for overexpressed markers, such as human epidermal growth factor receptor 2 gene and the use of neoadjuvant systemic treatments to downstage and improve overall outcomes, there has been an increase in rates of clinical complete response (CR) observed before surgical evaluation and confirmed postoperatively as pathological CR.

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