New Recommendations from ESTRO on Preoperative Radiation Therapy for Breast Cancer​

The 2025 ESTRO recommendations, endorsed by ASTRO, highlight the evolving role of preoperative radiation therapy (RT) in breast cancer management. Preoperative RT can optimise tumour downstaging, potentially improve surgical outcomes, and allow for better integration with systemic therapies. Current guidance emphasises careful patient selection, multidisciplinary planning, and integration with breast-conserving surgery, particularly in locally advanced or high-risk tumours.

Emerging evidence and ongoing trials are exploring optimal timing, fractionation, and combination strategies with systemic treatments, as well as identifying biomarkers to predict response and minimise toxicity. These recommendations underscore a shift toward more individualised, neoadjuvant approaches in breast cancer, positioning preoperative RT as a promising component of contemporary treatment strategies.