Advancing Precision and Access in Breast Radiation Oncology

In a discussion at the 2026 American College of Radiation Oncology (ACRO) Summit, Parul Barry, MD, a radiation oncologist at University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center and Magee-Womens Hospital, highlighted the evolving landscape of breast cancer treatment. Barry discussed the transition to shorter radiation schedules, the potential for combining systemic therapies with radiation, and the emerging role of theranostics and artificial intelligence in enhancing clinical workflows and patient outcomes.

CancerNetwork®: Are there any presentations that have stood out to you so far regarding breast radiation oncology?

Barry: Several presentations have explored shorter radiation schedules to make treatment more accessible, as well as optimizing regional nodal irradiation for patients with node-positive or high-risk breast cancer.

How has ultra-hypofractionated breast radiation changed clinical workflows and the patient experience?

The change has been dramatic, especially since the start of the COVID-19 pandemic, as we moved toward using 5-fraction schedules more frequently. We found that patient compliance and the ability to complete treatments within the scheduled time have increased, along with patient satisfaction. Completing treatment in 5 short sessions is a palatable way for patients to achieve a durable cure compared with traditional 5-to-7-week schedules.

As antibody-drug conjugates (ADCs) and targeted therapies move earlier into breast cancer care, how can radiation teams adapt sequencing and toxicity management strategies?

These therapies, such as HER2-directed ADCs or sacituzumab govitecan-hziy [Trodelvy], are critical for managing cancer. Integrating them with radiation for patients at high risk for relapse requires excellent communication between radiation oncologists, medical oncologists, and surgeons to ensure seamless transitions between treatments. Currently, we avoid concurrent use of radiation and ADCs due to toxicity concerns. However, there is significant interest in using them together in the future to potentiate effects in resistant, high-risk cancers.

Are there specific trials or trends in the breast cancer space that you are following closely?

I am interested in trials combining chemotherapy and radiation, such as studies for inflammatory breast cancer. There was also an ETCTN trial (NCT04052555) investigating berzosertib with radiation, and the combination of immunotherapy and radiation is very interesting for the high-risk population. I am focused on combining systemic therapy and radiation for the curative management of advanced and high-risk breast cancers.

Are you currently involved in any research that you would like to discuss?

At UPMC, we are conducting advanced research in the preoperative space by delivering radiation before surgery to assess cancer response. If we can eliminate the cancer with high-dose radiation before surgery, we can evaluate whether patients can de-escalate or skip systemic therapy, endocrine therapy, or even surgery. This involves a collaborative team focusing on precision radiation, medical, and surgical oncology. We also utilize translational researchers for rapid processing of ctDNA or immune function samples. Additionally, we are investigating theranostics and radiopharmaceutical therapy for all subtypes of metastatic breast cancer through multiple clinical trials.

What potential does theranostics have to propel the treatment of breast cancer?

For patients living with metastatic breast cancer as a chronic disease, the cancer can become resistant to systemic therapies over time. Radiopharmaceutical therapy offers a different mechanism that stimulates the immune system and treats the cancer differently. It can target specific proteins, such as fibroblast activation protein (FAP), and may sensitize metastatic cancers to future systemic therapies.

What topics would you like to see gain more attention within the radiation oncology community?

Compliance with endocrine therapy is approximately 50% in real-world data because patients often stop due to [adverse] effects like joint pain. Low-dose radiotherapy to the joints can reduce pain and improve mobility, allowing patients to continue their endocrine therapy. This is a way to treat benign disease to improve cancer cure rates. I also want to see more focus on using theranostics to radiosensitize patients who have been heavily pre-treated with systemic therapy.

Looking 3 to 5 years into the future, what developments are you anticipating?

I expect growth in surface guidance and more conformal boluses for post-mastectomy radiation, particularly for inflammatory breast cancer. Artificial intelligence will be extremely helpful for contouring and developing targets, which improves access and allows for timely treatment as we move toward 5-fraction regimens. We may also see the use of definitive primary radiation for early-stage breast cancer, like how it is used in lung cancer.

Is there anything else you would like to add about the state of breast radiation oncology?

This is an exciting time to be a breast radiation oncologist. We have many new developments on the horizon and can offer diverse options for patients through collaborative work with surgeons, medical oncologists, and survivorship teams.

Reference

Testing the addition of an anti-cancer drug, berzosertib, to the usual treatment (radiation therapy) for chemotherapy-resistant triple-negative and estrogen and/​or progesterone receptor positive, HER2 negative breast cancer. ClinicalTrials.gov. Updated February 2, 2026. Accessed February 6, 2026. https://tinyurl.com/2huubwt8