Editor's Note: The Chinese Anti-Cancer Association, adhering to the tenet of "prevention, screening, diagnosis, treatment, and rehabilitation," has launched the "Chinese Tumor Integrated Diagnosis and Treatment Guidelines." At the 2024 CACA Integrated Breast Cancer Conference, "Oncology Frontier" invited three authoritative experts from internal medicine, surgery, and radiotherapy—Dr. Man Li from The Second Hospital of Dalian Medical University, Dr. Yingying Xu from The First Hospital of China Medical University, and Dr. Jiayi Chen from Ruijin Hospital, Shanghai JiaoTong University School of Medicine—to discuss the comprehensive management of breast cancer patients under the theme of "Integration for Prevention, Screening, Diagnosis, Treatment, and Rehabilitation." Under the moderation of Dr. Wei Li from Jiangsu Province People's Hospital, the three experts explored key aspects of comprehensive breast cancer management from personalized treatment, multidisciplinary collaboration, minimally invasive techniques, to new advancements in radiotherapy, providing valuable practical experience and theoretical guidance for future breast cancer management.Dr. Wei Li: The Chinese Anti-Cancer Association, upholding the tenet of “prevention, screening, diagnosis, treatment, and rehabilitation,” has formulated the “Chinese Tumor Integrated Diagnosis and Treatment Guidelines,” the first of its kind in China and the first in the world to propose a comprehensive management system of “prevention, screening, diagnosis, treatment, and rehabilitation.” Our discussion today is based on this content, and we have invited three domestic experts in the field of breast cancer (internal medicine, radiotherapy, and surgery) to analyze patient management from different perspectives.
Radiotherapy is a crucial part of the comprehensive management process. We have invited Dr. Jiayi Chen, an expert in radiotherapy, to discuss how radiotherapy effectively integrates with other aspects of “prevention, screening, diagnosis, treatment, and rehabilitation” (such as diagnosis, surgery, internal medicine treatment, rehabilitation) to ensure that radiotherapy plans are coordinated with the overall treatment strategy.
Dr. Jiayi Chen: As the previous professors mentioned, after confirming the diagnosis of breast cancer, the next step is to categorize treatment. For breast cancer patients, surgery and chemotherapy are familiar treatments, but radiotherapy is often the most unfamiliar part of the treatment. Therefore, our primary task is to demystify radiotherapy. At Ruijin Hospital, we have a good comprehensive management model. Whether patients are early-stage or locally advanced breast cancer cases, they receive a pathology diagnosis and are informed in writing whether they need radiotherapy and the precise timing for starting radiotherapy, which is crucial for patients.
Furthermore, in terms of radiotherapy timing, there’s a positive trend towards shorter radiotherapy courses with fewer side effects. For patients undergoing breast-conserving therapy without adjuvant chemotherapy, we generally aim to start radiotherapy within eight weeks post-surgery but not earlier than four weeks post-surgery to avoid impacting radiotherapy positioning accuracy due to potential seroma. For patients receiving adjuvant chemotherapy, we recommend starting radiotherapy at least two weeks post-chemotherapy. Radiotherapy is an indispensable but flexible treatment that requires patients to maintain a relaxed state during treatment to benefit optimally.
Dr. Wei Li: Radiotherapy is indeed a crucial and indispensable part of comprehensive patient management. Professor Chen mentioned that during chemotherapy, there’s no need to strictly adhere to specific timelines as long as radiotherapy is conducted within the prescribed period, ensuring standardized treatment. Thank you again, Professor Chen.
In the first roundtable discussion, the three experts elaborated on the comprehensive management concept from surgical, internal medicine, and radiotherapy perspectives. In the second segment, we will discuss precision treatment, inviting the three experts to explain how precision treatment should be implemented in the comprehensive management process from their respective specialties.
With advancements in radiotherapy technology, techniques like stereotactic body radiotherapy (SBRT) are increasingly used in local treatment of breast cancer. Dr. Jiayi Chen, could you discuss the impact of these new technologies on breast cancer treatment and share how interdisciplinary collaboration can promote the application of new technologies in the “prevention, screening, diagnosis, treatment, and rehabilitation” system?
Dr. Jiayi Chen: The significance of stereotactic body radiotherapy in breast cancer treatment is twofold. Firstly, SBRT shortens the radiotherapy course for patients, reducing the traditional five-week course to three weeks, and for some patients, even down to five sessions in one week. Although this is a whole-breast radiotherapy protocol, the significant reduction in treatment duration meets SBRT standards, greatly reducing physical and psychological stress for patients and saving medical and non-medical resources.
Secondly, SBRT allows for a reduction in the radiation field. For some patients with brain metastases, whole-brain radiotherapy is now rare. Instead, we target specific lesions, even multiple lesions, with curative doses while preserving cognitive function. These new technologies require early diagnosis and timely integration with systemic treatments to enable patients to receive the necessary comprehensive care.
In the comprehensive management of “prevention, screening, diagnosis, treatment, and rehabilitation,” diagnosis and treatment are inevitable clinical encounters. Prevention and screening shift the disease interception to an earlier stage, while rehabilitation ensures better social reintegration for patients. Rehabilitation relies on reduced treatment toxicity, as mentioned by Dr. Yingying Xu, and involves patient education. As radiotherapy doctors, we are responsible for patient education since radiotherapy is often the final step in adjuvant treatment, making health education at this stage crucial. Integrated treatment requires every doctor to complete their part diligently, forming a vital link in the treatment chain. Only by taking our roles seriously can we close the loop.
Dr. Wei Li: Currently, SBRT is an important technology in patient precision treatment, providing good treatment outcomes and adherence. Professor Chen emphasized that in the process of “prevention, screening, diagnosis, treatment, and rehabilitation,” each doctor must perform their duties well to ensure the successful implementation of comprehensive management. Thank you again, Professor Chen.
Through the insights shared by the three experts, we realize that advancing comprehensive cancer management involves enhancing early diagnosis and treatment and raising public awareness of prevention and screening. This requires multidisciplinary collaboration, making the path ahead both challenging and crucial. This roundtable discussion has enlightened us on new concepts, knowledge, and technologies in breast cancer diagnosis and treatment, with the experts collectively exploring the challenges and hot topics in treatment. Thank you to all the experts for their participation. With everyone’s joint efforts, the level of breast cancer diagnosis and treatment will continue to improve, benefiting more patients.
Dr. Jiayi Chen
- Chief Physician, Doctoral Supervisor
- Director of Radiotherapy, Ruijin Hospital, Shanghai JiaoTong University School of MedicineIncoming
- Chair of the Tumor Radiotherapy Committee, Shanghai Medical Association
- Deputy Chair of the Integrated Breast Cancer Committee, Chinese Anti-Cancer Association
- Deputy Chair of the Integrated Oncology Cardiology Committee, Chinese Anti-Cancer Association
- Deputy Chair of the Neuro-Oncology Committee, Chinese Clinical Oncology Society (CSCO)
- Standing Committee Member of the Breast Cancer Committee, Chinese Clinical Oncology Society (CSCO)
- Standing Committee Member of the Tumor Radiotherapy Committee, Chinese Clinical Oncology Society (CSCO)
- Published over 90 papers as the first or corresponding author in domestic authoritative, core, and SCI journals
- Principal investigator of three National Natural Science Foundation general projects, two sub-projects of major projects of the Ministry of Science and Technology, and multiple research projects including the Shanghai Shenkang Hospital Development Center’s “Three-Year Action Plan” and Shanghai Municipal Science and Technology Commission’s support projects and natural funds
- Principal researcher of the first domestically developed simultaneous proton therapy system clinical trial
- Recipient of the “Shanghai March 8th Red Banner Bearer” and the sixth “National Famous Doctor Excellence Award”
Dr. Wei Li
- Jiangsu Province Hospital, Department of Oncology
- Doctor, Chief Physician, Associate Professor, Master’s Supervisor
- Member of the Breast Cancer Expert Committee, Chinese Clinical Oncology Society (CSCO)
- Standing Committee Member of the Youth Expert Committee, Chinese Clinical Oncology Society (CSCO)
- Member of the Breast Cancer Professional Committee, Chinese Anti-Cancer Association
- Member of the Tumor Targeted Therapy Professional Committee, Chinese Anti-Cancer Association
- Deputy Chair of the Yangtze River Academic League Breast Cancer Alliance (YBCSG)
- Standing Committee Member of the Tumor Molecular Targeted Therapy Professional Committee, Jiangsu Province Research Hospital
- Member of the Cancer Rehabilitation and Palliative Care Professional Committee, Jiangsu Anti-Cancer Association
- Young Talent of the “Science and Education Prosperity Project” in Jiangsu Province
- Visiting Scholar at the University of South Carolina School of Medicine
