Work

The value of breast brachytherapy boost in the current era: a narrative literature review from the GEC-ESTRO breast cancer working group

Year: 2026

Type: review

Abstract: Purpose: To identify patients who may benefit from an interstitial brachytherapy boost in the era of hypofractionation and widespread use of simultaneous integrated boost. Material and methods: Between 1984 and 2025, 112 articles were identified through a narrative search of the PubMed, MEDLINE, and Cochrane databases using the keywords "breast cancer", "boost", "interstitial brachytherapy", and "interventional radiotherapy". Two main areas were addressed: an update on risk factors and patient selection, and a review of boost techniques, with an emphasis on interstitial brachytherapy and comparisons with other techniques. Based on this evidence, we formulated recommendations on the role of brachytherapy boost in contemporary breast cancer (BC) treatment. Results: Based on the available literature, the addition of a boost should be strongly recommended for patients aged <40 years, patients with positive margins, and patients aged <50 years with at least one of the following features: high-grade disease, extensive intraductal carcinoma, and/or a triple-negative phenotype. In other scenarios, including residual disease after neoadjuvant chemotherapy, a balanced shared decision should be made. Interstitial brachytherapy allows delivery of a high radiation dose to the target volume while significantly reducing the dose received by adjacent organs at risk. Conclusion: The use of brachytherapy as a boost has declined, particularly since the introduction of integrated and ultra-hypofractionated regimens. In the current era of breast cancer treatment, we suggest that brachytherapy remains a valuable option for selected high-risk patients because it enables dose escalation tailored to the risk volume while sparing surrounding organs at risk.

Source: Clinical and Translational Radiation Oncology

DOI: 10.1016/j.ctro.2026.101324