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Breast cancer is the most common cancer in women worldwide and encompasses a broad spectrum of diseases in one with significant epidemiological, clinical, and biological heterogeneity, which determines a different natural history and prognostic profile. Although classical tumour staging (TNM) still provides valuable information, the current reality is that the clinicians must consider other biological and molecular factors that directly influence treatment decision-making. The management of breast cancer has changed radically in the last 15 years due to significant advances in our understanding of these tumours. This knowledge has brought with it a major impact regarding surgical and systemic management and has been practice-changing, but it has also created significant uncertainties regarding how best integrate the radiotherapy treatment into the therapeutic scheme. In parallel, radiotherapy itself has also experienced major advances, new radiobiological concepts have emerged, and genomic data and other patient-specific factors must now be integrated into individualised treatment approaches. In this context, “precision medicine” seeks to provide an answer to these open questions and uncertainties. The aim of the present review is to clarify the meaning of this term and to critically evaluate its role and impact on contemporary breast cancer radiotherapy. Sin financiación No data JCR 2021 0.269 SJR (2021) Q3, 1780/2489 Medicine (miscellaneous) No data IDR 2021 UEM

Simple Summary Given that the majority of breast cancer patients receive adjuvant radiation therapy and/or systemic treatments that can enhance cardiovascular risk, it is imperative to consider a multidisciplinary approach to cardiovascular care and to develop strategies to identify and prevent radiation-associated cardiotoxicity. In this review, we seek to analyze the evidence of the mechanisms underlying cardiac damage secondary to breast irradiation, the impact of factors related to the patient herself, and the treatments administered, as well as to describe different strategies for reducing risks and managing radiation-induced heart disease if it has already occurred. All this with the aim of improving not only survival but also the quality of life for our patients. Abstract In recent decades, improvements in breast cancer management have increased overall patient survival; however, many cancer therapies have been linked to an important risk of cardiovascular adverse events. Cardio-oncology has been proposed as an emerging specialty to coordinate preventive strategies that improve the cardiovascular health of oncologic patients. It employs the most suitable personalized multidisciplinary management approach for each patient to optimize their cardiovascular health and improve their survival and quality of life. Radiotherapy is an essential part of the therapeutic regimen in breast cancer patients but can also increase the risk of cardiovascular disease. Therefore, minimizing the negative impact of radiation therapy is an important challenge for radiotherapy oncologists and cardiologists specializing in this field. The aim of the present review is to update our knowledge about radiation-induced cardiotoxicity in breast cancer patients by undertaking a critical review of the relevant literature to determine risk prevention and control strategies currently available.

In developed countries, breast cancer (BC) is the most common type of cancer in women, mainly affecting patients over age 60. Due to the increasing life expectancy and population ageing, the incidence of BC is expected to increase significantly in the coming years. However, no standardized clinical guidelines are available to assist in decision-making in elderly patients. Moreover, there is a lack of quality scientific evidence to guide treatment selection in this patient population, who are underrepresented in clinical trials. Consequently, up to 50% of elderly women are treated suboptimally, which implies a worse prognosis and survival. Given that the current estimated life expectancy of a healthy 70-year-old woman is 15 years, any treatment capable of reducing the likelihood of disease recurrence and cancer-specific mortality in this patient population would be beneficial. Adjuvant radiotherapy (RT) is one of the pillars of treatment for BC and it plays a key role in improving local control (LC) and overall survival (OS). Adjuvant RT is clearly indicated in young patients who undergo breast-conserving surgery (BCS) as well as in high risk patients, regardless of age. However, the use of adjuvant RT in older patients with early-stage disease has decreased in recent years—even in patients who undergo BCS—due to outdated concerns about the possible side effects of RT and reports suggesting that RT can be omitted in low-risk patients. One of the greatest challenges currently facing radiation oncologists who specialise in the treatment of BC is the selection of elderly patients who are likely to benefit from adjuvant RT. There is also a clear need to critically evaluate the available evidence and to apply those findings to routine clinical practice. Given this context, the aim of the present review is to clarify the current role of adjuvant RT in the management of BC in older women—particularly those with early-stage disease—and to dispel the myths surrounding the use of RT to treat elderly women. This review primarily focuses on the indications, controversies, and irradiation techniques used in this patient subgroup. Sin financiación 1.241 JCR (2020) Q4, 233/242 Oncology 0.254 SJR (2020) Q4, 183/211 Cancer Research No data IDR 2020 UEM