Is primary radiotherapy or radiochemotherapy indicated?

Radiotherapy together with surgery and systemic treatment, represent the therapeutic triad for breast cancer patients, achieving high control and survival rates. In recent years we have witnessed a (r)evolution in the conception of breast cancer treatment. The classic scheme of surgery followed by systemic treatment and radiotherapy is falling into disuse, with the preoperative administration of systemic treatment being proposed instead, seeking to maximize its effect and favoring not only more conservative surgeries but also, in selected cases, even increasing the rates of disease-free survival and overall survival. Radiotherapy, in turn, is also evolving towards a change of perspective: preoperative administration of radiotherapy can be useful in selected groups. Advances in radiobiological knowledge, together with technological improvements that are constantly being incorporated into clinical practice, favor the administration of radiotherapy in an increasingly precise and effective manner, as well as safe even in combination with drugs in the preoperative setting. In this article, we have reviewed the usefulness of preoperative radiotherapy for breast cancer patients and the possibilities of combination with other therapies. (c) 2023 SESPM. Published by Elsevier Espana, S.L.U. All rights reserved.