Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2021, 165(1):19-25 | DOI: 10.5507/bp.2021.007

Controversies of radiotherapy in human epidermal growth factor receptor (HER)-2 positive breast cancer patients

Iveta Kolarovaa,b, Bohuslav Melichara,c,d, Jaroslav Vanasekb,e, Ales Ryskaf, Katerina Horackovab, Jiri Peteraa,d, Milan Vosmika,d, Igor Siraka,d, Martin Dolezelc,g
a Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
b Faculty of Health Studies, Pardubice University, Pardubice, Czech Republic
c Department of Oncology, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, Czech Republic
d Department of Oncology and Radiotherapy, Faculty of Medicine in Hradec Kralove, Charles University, Czech Republic
e Oncology Centre, Multiscan, Pardubice, Czech Republic
f The Fingerland Department of Pathology, Charles University Medical Faculty and University Hospital Hradec Kralove, Czech Republic
g Department of Oncology, First Faculty of Medicine, Charles University, Prague, Czech Republic

Tumor biology plays a crucial role in the systemic treatment, specifically in HER2-positive tumors. Distinct biological behavior of breast cancer subtypes is associated with different rates of locoregional recurrence (LRR). HER2- positive breast cancer patients treated with surgery in combination with radiation, without trastuzumab have poor outcome, including high LRR. The efficacy of radiotherapy in HER-2-positive breast cancer appears to be associated with the expression of estrogen receptors. In patients with HER-2-positive breast cancer, studies conducted before the introduction of trastuzumab indicated higher benefit of adjuvant radiation in patients with hormone receptor-positive tumors compared to patients with tumors not expressing hormone receptors. The introduction of agents targeting HER-2 has transformed the management of these patients, resulting in improved outcomes. The data of clinical studies show that the administration of trastuzumab as part of a multimodality approach (with radiation based on standard guidelines) results in improved outcomes, including lower locoregional recurrence. The risk of cardiac toxicity associated with radiation to the heart and administration of potential cardiotoxic trastuzumab is not clear. In patients treated concomitantly with regional lymph node irradiation and anti-HER-2 agents after prior anthracycline-based chemotherapy minimizing the dose to the myocardium, e.g. respiratory gating or proton beam radiotherapy, have been suggested.

Keywords: breast cancer, radiation therapy, HER-2, locoregional recurrence, trastuzumab

Received: October 8, 2020; Revised: November 26, 2020; Accepted: January 15, 2021; Prepublished online: February 4, 2021; Published: March 12, 2021  Show citation

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Kolarova, I., Melichar, B., Vanasek, J., Ryska, A., Horackova, K., Petera, J., ... Dolezel, M. (2021). Controversies of radiotherapy in human epidermal growth factor receptor (HER)-2 positive breast cancer patients. Biomedical papers, 165(1), 19-25. doi: 10.5507/bp.2021.007
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