Frontiers and future directions in radiotherapy for breast cancer: considerations of net clinical benefit

Sun Jianguo; Niu Kai

doi:10.16016/j.2097-0927.202608049

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Frontiers and future directions in radiotherapy for breast cancer: considerations of net clinical benefit

Expert Review | 更新时间：2026-10-01

- Frontiers and future directions in radiotherapy for breast cancer: considerations of net clinical benefit
- Journal of Army Medical University Vol. 48, Issue 18, Pages: 2517-2529(2026)
- 作者机构：
  
  陆军军医大学（第三军医大学）第二附属医院肿瘤科，重庆
- 作者简介：
  
  Sun Jianguo， E-mail： sunjg09@aliyun.com
- 基金信息：
  
  Sun Jianguo And Niu Kai Contributed equally to this article. Supported by the National Natural Science Foundation of China(82473261;81272910);the Key Research and Development Program of Chongqing(CSTB2022TIAD-KPX0176)
- DOI：10.16016/j.2097-0927.202608049
  CLC： R730.55;R737.9
- Received：17 August 2026，
  
  Revised：2026-09-04，
  
  Accepted：12 September 2026，
  
  Published：30 September 2026
- 稿件说明：
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孙建国，牛凯.乳腺癌放射治疗前沿进展与未来方向的临床净获益考量［J］.陆军军医大学学报，2026，48（18）：2517-2529.DOI：10.16016/j.2097-0927.202608049.

Sun J G，Niu K.Frontiers and future directions in radiotherapy for breast cancer： considerations of net clinical benefit［J］.J Army Med Univ，2026，48（18）：2517-2529.DOI：10.16016/j.2097-0927.202608049.
孙建国，牛凯.乳腺癌放射治疗前沿进展与未来方向的临床净获益考量［J］.陆军军医大学学报，2026，48（18）：2517-2529.DOI：10.16016/j.2097-0927.202608049. DOI：

Sun J G，Niu K.Frontiers and future directions in radiotherapy for breast cancer： considerations of net clinical benefit［J］.J Army Med Univ，2026，48（18）：2517-2529.DOI：10.16016/j.2097-0927.202608049. DOI：

摘要

乳腺癌放射治疗正在经历治疗简化、技术升级和联合治疗的3个发展方向。本文以临床净获益为核心评判主线，系统梳理乳腺癌放射治疗的前沿进展，据此提出以下核心观点：第一，光子放疗26 Gy/5次乳腺或胸壁照射、40 Gy/15次区域淋巴结照射等术后放疗方案已获充分循证支持。第二，部分低复发风险患者可豁免术后放疗，术后放疗的绝对获益较小。第三，质子放疗在特定人群中有明确的临床净获益，碳离子放疗、硼中子俘获治疗仅有少量样本探索，FLASH技术尚处于剂量学研究阶段。第四，HER2抗体偶联药物、CDK4/6抑制剂及免疫治疗等，在限定场景与放疗联合应用，有效性和安全性有待验证。第五，乳腺癌放射治疗的发展方向不是单个技术路线，而是按分层决策来制定体系。本文以临床净获益为考量，分析乳腺癌各类放疗技术的适用边界、证据缺口和未来方向，为乳腺癌放疗的推广应用奠定基础。

Abstract

Breast cancer radiotherapy is simultaneously undergoing a triple transformation: treatment de-escalation

technical refinement

and multidisciplinary collaboration. Two seemingly contradictory development paths have emerged in the field: treatment de-escalation and equipment/technology upgrading. Taking clinical net benefit as the core evaluation principle

this article systematically reviews cutting-edge advances in the field and puts forward the following core viewpoints. First

in photon radiotherapy

regimens such as 26 Gy in 5 fractions for breast or chest wall irradiation and 40 Gy in 15 fractions for regional nodal irradiation have obtained sufficient evidence-based support; the core criterion for omitting radiotherapy is not merely identifying patients at low risk of recurrence

but rather demonstrating that the absolute benefit of radiotherapy is so marginal that patients are willing to forgo it. Second

proton therapy can be adopted after confirming the absolute benefit threshold through dual-plan comparison

whereas carbon ion therapy

boron neutron capture therapy

and FLASH radiotherapy remain insufficiently mature and cannot directly replace established photon therapy. Third

the combination of HER2-directed antibody-drug conjugates

CDK4/6 inhibitors

and immunotherapy with radiotherapy can be implemented in limited clinical scenarios; however

short-term feasibility does not equate to long-term safety

retrospective associations do not equate to causality

and local efficacy does not equate to synergistic enhancement. Fourth

breast cancer radiotherapy in the future will not evolve along a single technology substitution route

but will develop into a complete clinical system of tiered decision-making. This article establishes a tiered decision-making framework for breast cancer radiotherapy centered on clinical net benefit

clarifies the applicable boundaries and evidence gaps of various technologies

and provides a practical reference for the homogenized promotion of breast radiotherapy.

关键词

Keywords

references

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