Cancer recurrence rates after breast-conserving surgery with and without adjuvant radiation therapy with Radiological examination: a systematic review

Breast-conserving surgery (BCS) is a standard treatment for early-stage breast cancer, often combined with adjuvant radiation therapy (RT) to reduce local recurrence. Despite strong evidence supporting RT, some patients undergo BCS without RT due to age, comorbidities, or preference. Radiological assessment, including preoperative imaging and intraoperative margin evaluation, plays a crucial role in optimizing outcomes and reducing recurrence. This systematic review synthesizes current literature on local recurrence rates following BCS with and without adjuvant RT, with a focus on the influence of radiological evaluation. A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Library from ۲۰۰۰ to ۲۰۲۵ was conducted, yielding ۴۲ studies including randomized controlled trials, population-based cohorts, and meta-analyses. The findings consistently demonstrate that BCS without RT results in significantly higher local recurrence (۱۰–۳۵%) compared to BCS with RT (۵–۱۰%). Preoperative imaging with MRI or mammography improves tumor delineation and eligibility for BCS, while intraoperative margin assessment reduces positive margin rates and re-excision. Subgroup analyses indicate that selected low-risk patients (e.g., age >۷۰, small low-grade tumors, hormone receptor-positive) may have acceptable recurrence rates without RT, though radiological guidance remains essential. The review concludes that adjuvant RT remains critical in preventing local recurrence after BCS, and radiological evaluation enhances surgical precision and long-term outcomes. Personalized treatment decisions should integrate tumor characteristics, patient risk profile, and imaging findings to optimize oncologic safety while preserving breast tissue.

کلیدواژه ها:

RCTs ، population studies ، bilateral mastectomy data ، intraoperative imaging ، and neoadjuvant imaging results