Dr Indrani Bhattacharya was appointed as a consultant clinical oncologist in Cambridge University Hospitals NHS Foundation Trust in August 2020. She has expertise in technical breast radiotherapy and clinical trials radiotherapy quality assurance as well as delivery of systemic therapies for breast cancer patients. She completed a 3-year CRUK clinical trials fellowship and PhD in The Institute of Cancer Research's Clinical Trials and Statistics Unit working within the portfolio of breast radiotherapy trials including the IMPORT and PRIMETIME studies. During this time she worked on studies of patient-reported outcomes and developed decision aids in collaboration with patients. She is currently the patient-reported outcomes lead in the UK breast proton PARABLE study. She is a member of the FAST FORWARD, IMPORT, PRIMETIME and KORTUC trial management groups.  She also has an interest in risk-adapted breast radiotherapy, delivering new radiotherapy technologies and developing drug-radiotherapy combinations.  

Breast radiotherapy following breast conserving surgery (BCS) has been a well-established component of treatment for patients with early breast cancer for several decades. For example, START-B compared 40Gy/15 fractions (F) over 3-weeks with 50Gy/25F over 5-weeks and found equivalent local control and less toxicity in the hypofractionation group, leading to the 3-week regimen becoming standard of care. Building on this, FAST FORWARD compared the 3-week regimen with 1-week (26Gy and 27Gy each in 5F) and found with 26Gy/5F, local control was equivalent with no increase in toxicity. The timely reporting of FAST FORWARD amidst the COVID-19 pandemic meant that many patients continued to have radiotherapy with fewer hospital visits. It is well known that breast radiotherapy reduces risk of local relapse but it is not without risk. With changes in breast cancer care and improved patient survivorship, the risk-benefit ratio of breast radiotherapy is changing. The blanket rule of whole breast radiotherapy for all patients following BCS is no longer applicable. Radiotherapy must be adapted and tailored to the risk profile of individual patients. For example, the testing of partial breast irradiation (PBI) in low-risk patients within IMPORT LOW or using biomarkers to identify which patients can safely avoid radiotherapy in PRIMETIME. There is also the potential to modulate dose across the breast and escalate dose to the tumour bed in high-risk patients in IMPORT HIGH. The role of nodal radiotherapy in high-risk patients will also be discussed as well as the role of protons and the UK PARABLE trial. This presentation aims to highlight the key trials in delivering risk adapted breast radiotherapy.