The Evolving Role of Radiation Therapy in Managing Metastatic Breast Cancer

Purpose of Review: Metastatic breast cancer comprises of a variety of heterogeneous clinical scenarios. There are many factors that help guide appropriate treatment based on biology of breast cancer as determined by receptor status, disease free interval and extent of metastatic disease among others. While systemic therapy remains the mainstay of treatment, the role of Radiation therapy is evolving as patients are living longer. The aim of this article is to review the current evidence for RT recommendations in patients with oligometastatic disease, cerebral and skeletal metastases as well as locally advanced disease requiring palliation. Considering unique nature of each case, multidisciplinary management is essential. Recent Findings: Over the past decade, systemic therapy has become more effective with chemotherapy, immunotherapy, targeted and endocrine therapy significantly contributing to improved overall survival and disease-free survival. Radiation therapy likewise has seen significant innovation with wider adoption of hypofractionated regimens, FSRT and SBRT that allows for dose escalation while limiting toxicity to normal structures and with less interruptions to planned systemic therapy. Dose-intensified radiotherapy has allowed for change in role of RT from short-term palliation to durable local control of metastases and improved pain response rates. Summary: Radiation therapy is a commonly utilized modality in metastatic breast cancer. In this review article we discuss various applications based on the site of metastases, extent of disease and symptoms as well as patient and disease specific factors.