Adjuvant whole-breast irradiation following breast-conserving surgery is a well-established treatment standard for early invasive breast cancer. Screening, early diagnosis, surgical technique refinement, knowledge of new and specific molecular prognostic factors, and now the standard use of more effective neo/adjuvant systemic therapies have all played a role in lowering the rates of locoregional relapses. This highlights the importance of reliably identifying women with such low-risk disease burdens in whom removing radiation from the treatment plan would not jeopardise oncological safety. This review summarises the current evidence for radiation de-intensification strategies and details ongoing prospective clinical trials investigating the omission of adjuvant whole breast irradiation in molecularly defined low-risk breast cancers, as well as related evidence supporting the potential for radiation de-escalation in triple-negative clinical subtypes.
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