В статье представлен развернутый обзор современных стандартов и перспективных направлений развития лучевой терапии при тройном негативном раке молочной железы. Рассмотрены последние достижения в диагностике и лечении данного агрессивного типа рака, включая внедрение передовых методов лучевой терапии, таких как стереотаксическое облучение, модулированная по интенсивности лучевая терапия и интраоперационное облучение. Особое внимание уделено вопросам оптимизации режимов лечения, снижению вероятности побочных эффектов и повышению качества жизни пациентов. Описаны подходы к сочетанному применению лучевой терапии с химиотерапией, иммунотерапией и таргетной терапией, а также рассмотрены перспективы персонализированной терапии на основе молекулярно-генетических характеристик опухоли. Проанализированы результаты актуальных клинических исследований, направленных на поиск наиболее эффективных тактик лечения. Подчеркнута важность мультидисциплинарного подхода, предполагающего активное взаимодействие онкологов, радиологов и других специалистов. Определено также влияние новых технологий и персонализированной медицины на развитие лучевой терапии, включая использование искусственного интеллекта и биомаркеров для индивидуального подбора терапии. Дополнительно обсуждены вопросы радиобиологии, механизмы радиорезистентности опухолевых клеток и возможные способы их преодоления с целью повышения эффективности терапии и улучшения прогноза для пациенток с тройным негативным раком молочной железы.

triple negative breast cancerradiation therapymodern standardsfuture directionssystemic therapypersonalized approachтройной негативный рак молочной железылучевая терапиясовременные стандартыбудущие направлениясистемная терапияперсонифицированный подход1.Andreev DA, Zavyalov AA. Triple-negative breast cancer: new options for systemic targeted therapy. A review. Journal of Modern Oncology. 2022;24(3):368–372. EDN: SARUWK doi: 10.26442/18151434.2022.3.201767Андреев Д.А., Завьялов А.А. Рак молочной железы с тройным негативным фенотипом: новые опции системной таргетной терапии // Современная онкология. 2022. Т. 24, № 3. C. 368–372. EDN: SARUWK doi: 10.26442/18151434.2022.3.2017672.Vtorushin SV, Krakhmal NV, Zavyalova MV. Triple-negative breast cancer. Modern molecular genetic concepts and their clinical significance. Russian Journal of Archive of Pathology. 2021;83(2):46–51. EDN: DHFZXP doi: 10.17116/patol20218302146Вторушин С.В., Крахмаль Н.В., Завьялова М.В. Тройной негативный рак молочной железы. Современные молекулярно-генетические представления и их клиническое значение // Архив патологии. 2021. Т. 83, № 2. С. 46-51. EDN: DHFZXP doi: 10.17116/patol202183021463.Smirmova OV, Borisov VI, Guens GP. Immediate and long-term outcomes of drug treatment in patients with metastatic triple negative breast cancer. Malignant tumours. 2018;8(3):68–77. EDN: KJOLFM doi: 10.18027/2224-5057-2018-8-3-68-77Смирнова О.В., Борисов В.И., Генс Г.П. Непосредственные и отдаленные результаты лекарственного лечения больных с метастазами тройного негативного рака молочной железы // Злокачественные опухоли. 2018. Т. 8, № 3. С. 68–77. EDN: KJOLFM doi: 10.18027/2224-5057-2018-8-3-68-774.de Araújo RA, Cordero da Luz FA, da Costa Marinho E, et al. Operable breast cancer: How not to worsen the prognosis, especially in triple negative and stage II tumors. Surg Oncol. 2021;38:101596. doi: 10.1016/j.suronc.2021.101596de Araújo R.A., Cordero da Luz F.A., da Costa Marinho E., et al. Operable breast cancer: How not to worsen the prognosis, especially in triple negative and stage II tumors // Surg Oncol. 2021. Vol. 38. P. 101596. doi: 10.1016/j.suronc.2021.1015965.Early Breast Cancer Trialists’ Collaborative Group (EBCTCG); Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378(9804):1707–1716. doi: 10.1016/S0140-6736(11)61629-2Early Breast Cancer Trialists’ Collaborative Group (EBCTCG); Darby S., McGale P., et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials // Lancet. 2011. Vol. 378, N 9804. P. 1707–1716. doi: 10.1016/S0140-6736(11)61629-26.Voduc KD, Cheang MC, Tyldesley S, et al. Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol. 2010;28(10):1684–1691. doi: 10.1200/JCO.2009.24.9284Voduc K.D., Cheang M.C., Tyldesley S., et al. Breast cancer subtypes and the risk of local and regional relapse // J Clin Oncol. 2010. Vol. 28, N 10. P. 1684–1691. doi: 10.1200/JCO.2009.24.92847.Wang J, Xie X, Wang X, et al. Locoregional and distant recurrences after breast conserving therapy in patients with triple-negative breast cancer: a meta-analysis. Surg Oncol. 2013;22(4):247–255. doi: 10.1016/j.suronc.2013.10.001Wang J., Xie X., Wang X., et al. Loco regional and distant recurrences after breast conserving therapy in patients with triple-negative breast cancer: a meta-analysis // Surg Oncol. 2013. Vol. 22, N 4. P. 247–255. doi: 10.1016/j.suronc.2013.10.0018.Arvold ND, Taghian AG, Niemierko A, et al. Age, breast cancer subtype approximation, and local recurrence after breast-conserving therapy. J Clin Oncol. 2011;29(29):3885–3891. doi: 10.1200/JCO.2011.36.1105Arvold N.D., Taghian A.G., Niemierko A., et al. Age, breast cancer subtype approximation, and local recurrence after breast-conserving therapy // J Clin Oncol. 2011. Vol. 29, N 29. P. 3885–3891. doi: 10.1200/JCO.2011.36.11059.Gangi A, Chung A, Mirocha J, et al. Breast-conserving therapy for triple-negative breast cancer. JAMA Surg. 2014;149(3):252–258. doi: 10.1001/jamasurg.2013.3037Gangi A., Chung A., Mirocha J., et al. Breast-conserving therapy for triple-negative breast cancer // JAMA Surg. 2014. Vol. 149, N 3. P. 252–258. doi: 10.1001/jamasurg.2013.303710.Sjöström M, Lundstedt D, Hartman L, et al. Response to radiotherapy after breast-conserving surgery in different breast cancer subtypes in the Swedish Breast Cancer Group 91 Radiotherapy Randomized Clinical Trial. J Clin Oncol. 2017;35(28):3222–3229. doi: 10.1200/JCO.2017.72.7263Sjöström M., Lundstedt D., Hartman L., et al. Response to radiotherapy after breast-conserving surgery in different breast cancer subtypes in the Swedish breast cancer group 91 radiotherapy randomized clinical trial // J Clin Oncol. 2017. Vol. 35, N 28. P. 3222–3229. doi: 10.1200/JCO.2017.72.726311.Loibl S, André F, Bachelot T, et al. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2024;35(2):159–182. doi: 10.1016/j.annonc.2023.11.016Loibl S., André F., Bachelot T., et al. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up // Ann Oncol. 2024. Vol. 35, N 2. P. 159–182. doi: 10.1016/j.annonc.2023.11.01612.Kunkler IH, Williams LJ, Jack WJL, et al. Breast-conserving surgery with or without irradiation in early breast cancer. N Engl J Med. 2023;388(7):585–594. doi: 10.1056/NEJMoa2207586Kunkler I.H., Williams L.J., Jack W.J.L., et al. Breast-conserving surgery with or without irradiation in early breast cancer // N Engl J Med. 2023. Vol. 388, N 7. P. 585–594. doi: 10.1056/NEJMoa220758613.Hughes KS, Schnaper LA, Berry D, et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med. 2004;351(10):971–977. doi: 10.1056/NEJMoa040587Hughes K.S., Schnaper L.A., Berry D., et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer // N Engl J Med. 2004. Vol. 351, N 10. P. 971–977. doi: 10.1056/NEJMoa04058714.Zhai Z, Zheng Y, Yao J, et al. Evaluation of adjuvant treatments for T1 N0 M0 triple-negative breast cancer. JAMA Netw Open. 2020;3(11):e2021881. doi: 10.1001/jamanetworkopen.2020.21881Zhai Z., Zheng Y., Yao J., et al. Evaluation of adjuvant treatments for T1 N0 M0 triple-negative breast cancer // JAMA Netw Open. 2020. Vol. 3, N 11. P. e2021881. doi: 10.1001/jamanetworkopen.2020.2188115.Haque W, Verma V, Hsiao KY, et al. Omission of radiation therapy following breast conservation in older (≥70 years) women with T1-2N0 triple-negative breast cancer. Breast J. 2019;25(6):1126–1133. doi: 10.1111/tbj.13443Haque W., Verma V., Hsiao K.Y., et al. Omission of radiation therapy following breast conservation in older (≥70 years) women with T1-2N0 triple-negative breast cancer // Breast J. 2019. Vol. 25, N 6. P. 1126–1133. doi: 10.1111/tbj.1344316.Algan O, Zhao YD, Herman T. Radiotherapy in patients 70 years and older with triple-negative breast cancer. Clin Breast Cancer. 2016;16(4):e99–e106. doi: 10.1016/j.clbc.2016.05.011Algan O., Zhao Y.D., Herman T. Radiotherapy in patients 70 years and older with triple-negative breast cancer // Clin Breast Cancer. 2016. Vol. 16, N 4. P. 99–106. doi: 10.1016/j.clbc.2016.05.01117.Whelan TJ, Pignol JP, Levine MN, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362(6):513–520. doi: 10.1056/NEJMoa0906260Whelan T.J., Pignol J.P., Levine M.N., et al. Long-term results of hypofractionated radiation therapy for breast cancer // N Engl J Med. 2010. Vol. 362, N 6. P. 513–520. doi: 10.1056/NEJMoa090626018.Offersen BV, Alsner J, Nielsen HM, et al. Hypofractionated versus standard fractionated radiotherapy in patients with early breast cancer or ductal carcinoma in situ in a randomized phase III trial: the DBCG HYPO trial. J Clin Oncol. 2020;38(31):3615–3625. doi: 10.1200/JCO.20.01363Offersen B.V., Alsner J., Nielsen H.M., et al. Hypofractionated versus standard fractionated radiotherapy in patients with early breast cancer or ductal carcinoma in situ in a randomized phase III trial: The DBCG HYPO trial // J Clin Oncol. 2020. Vol. 38, N 31. P. 3615–3625. doi: 10.1200/JCO.20.0136319.Smith BD, Bellon JR, Blitzblau R, et al. Radiation therapy for the whole breast: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol. 2018;8(3):145–152. doi: 10.1016/j.prro.2018.01.012Smith B.D., Bellon J.R., Blitzblau R., et al. Radiation therapy for the whole breast: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline // Pract Radiat Oncol. 2018. Vol. 8, N 3. P. 145–152. doi: 10.1016/j.prro.2018.01.01220.Brunt AM, Haviland JS, Sydenham M, et al. Ten-year results of FAST: a randomized controlled trial of 5-fraction whole-breast radiotherapy for early breast cancer. J Clin Oncol. 2020;38(28):3261–3272. doi: 10.1200/JCO.19.02750Brunt A.M., Haviland J.S., Sydenham M., et al. Ten-Year results of fast: a randomized controlled trial of 5-fraction whole-breast radiotherapy for early breast cancer // J Clin Oncol. 2020. Vol. 38, N 28. P. 3261–3272. doi: 10.1200/JCO.19.0275021.Murray Brunt A, Haviland JS, Wheatley DA, et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet. 2020;395(10237):1613–1626. doi: 10.1016/S0140-6736(20)30932-6Murray Brunt A., Haviland J.S., Wheatley D.A., et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial // Lancet. 2020. Vol. 395, N 10237. P. 1613–1626. doi: 10.1016/S0140-6736(20)30932-622.Meattini I, Becherini C, Boersma L, et al. European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice consensus recommendations on patient selection and dose and fractionation for external beam radiotherapy in early breast cancer. Lancet Oncol. 2022;23(1):e21–e31. doi: 10.1016/S1470-2045(21)00539-8Meattini I., Becherini C., Boersma L., et al. European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice consensus recommendations on patient selection and dose and fractionation for external beam radiotherapy in early breast cancer // Lancet Oncol. 2022. Vol. 23, N 1. P. 21–31. doi: 10.1016/S1470-2045(21)00539-823.Bartelink H, Maingon P, Poortmans P, et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015;16(1):47–56. doi: 10.1016/S1470-2045(14)71156-8Bartelink H., Maingon P., Poortmans P., et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial // Lancet Oncol. 2015. Vol. 16, N 1. P. 47–56. doi: 10.1016/S1470-2045(14)71156-824.Romestaing P, Lehingue Y, Carrie C, et al. Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France. J Clin Oncol. 1997;15(3):963–968. doi: 10.1200/JCO.1997.15.3.963Romestaing P., Lehingue Y., Carrie C., et al. Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France // J Clin Oncol. 1997. Vol. 15, N 3. P. 963–968. doi: 10.1200/JCO.1997.15.3.96325.Vrieling C, van Werkhoven E, Maingon P, et al. Prognostic factors for local control in breast cancer after long-term follow-up in the eortc boost vs no boost trial: a randomized clinical trial. JAMA Oncol. 2017;3(1):42–48. doi: 10.1001/jamaoncol.2016.3031Vrieling C., van Werkhoven E., Maingon P., et al. Prognostic factors for local control in breast cancer after long-term follow-up in the EORTC boost vs no boost trial: a randomized clinical trial // JAMA Oncol. 2017. Vol. 3, N 1. P. 42–48. doi: 10.1001/jamaoncol.2016.303126.Vicini FA, Winter K, Freedman GM, et al. NRG RTOG 1005: a phase III trial of Hypo Fractionated whole breast irradiation with concurrent Boost vs. Conventional whole breast irradiation plus sequential Boost following lumpectomy for high risk early-stage breast cancer. Int J Radiat Oncol Bio Phys. 2022;114(3):S1. doi: 10.1016/j.ijrobp.2022.07.2320Vicini F.A., Winter K., Freedman G.M., et al. NRG RTOG 1005: a phase III trial of Hypo Fractionated whole breast irradiation with concurrent boost vs. conventional whole breast irradiation plus sequential boost following lumpectomy for high risk early-stage breast cancer // Int J Radiat Oncol Bio Phys. 2022. Vol. 114, N 3. P. S1. doi: 10.1016/j.ijrobp.2022.07.232027.McHaffie DR, Patel RR, Adkison JB, et al. Outcomes after accelerated partial breast irradiation in patients with ASTRO consensus statement cautionary features. Int J Radiat Oncol Biol Phys. 2011;81(1):46–51. doi: 10.1016/j.ijrobp.2010.05.011McHaffie D.R., Patel R.R., Adkison J.B., et al. Outcomes after accelerated partial breast irradiation in patients with ASTRO consensus statement cautionary features // Int J Radiat Oncol Biol Phys. 2011. Vol. 81, N 1. P. 46–51. doi: 10.1016/j.ijrobp.2010.05.01128.Stull TS, Catherine Goodwin M, Gracely EJ, et al. A single-institution review of accelerated partial breast irradiation in patients considered “cautionary” by the American Society for Radiation Oncology. Ann Surg Oncol. 2012;19(2):553–559. doi: 10.1245/s10434-011-1941-7Stull T.S., Catherine Goodwin M., Gracely E.J., et al. A single-institution review of accelerated partial breast irradiation in patients considered “cautionary” by the American Society for Radiation Oncology // Ann Surg Oncol. 2012. Vol. 19, N 2. P. 553–559. doi: 10.1245/s10434-011-1941-729.Pashtan IM, Recht A, Ancukiewicz M, et al. External beam accelerated partial-breast irradiation using 32 gy in 8 twice-daily fractions: 5-year results of a prospective study. Int J Radiat Oncol Biol Phys. 2012;84(3):e271–277. doi: 10.1016/j.ijrobp.2012.04.019Pashtan I.M., Recht A., Ancukiewicz M., et al. External beam accelerated partial-breast irradiation using 32 gy in 8 twice-daily fractions: 5-year results of a prospective study // Int J Radiat Oncol Biol Phys. 2012. Vol. 84, N 3. P. 271–277. doi: 10.1016/j.ijrobp.2012.04.01930.Orecchia R, Veronesi U, Maisonneuve P, et al. Intraoperative irradiation for early breast cancer (ELIOT): long-term recurrence and survival outcomes from a single-center, randomised, phase 3 equivalence trial. Lancet Oncol. 2021;22(5):597–608. doi: 10.1016/S1470-2045(21)00080-2Orecchia R., Veronesi U., Maisonneuve P., et al. Intraoperative irradiation for early breast cancer (ELIOT): long-term recurrence and survival outcomes from a single-center, randomised, phase 3 equivalence trial // Lancet Oncol. 2021. Vol. 22, N 5. P. 597–608. doi: 10.1016/S1470-2045(21)00080-231.Meattini I, Marrazzo L, Saieva C, et al. accelerated partial-breast irradiation compared with whole-breast irradiation for early breast cancer: long-term results of the randomized phase III APBI-IMRT-florence trial. J Clin Oncol. 2020;38(35):4175–4183. doi: 10.1200/JCO.20.00650Meattini I., Marrazzo L., Saieva C., et al. Accelerated partial-breast irradiation compared with whole-breast irradiation for early breast cancer: long-term results of the randomized phase III APBI-IMRT-Florence Trial // J Clin Oncol. 2020. Vol. 38, N 35. P. 4175–4183. doi: 10.1200/JCO.20.0065032.Whelan TJ, Julian JA, Berrang TS, et al. External beam accelerated partial breast irradiation versus whole breast irradiation after breast conserving surgery in women with ductal carcinoma in situ and node-negative breast cancer (RAPID): a randomised controlled trial. Lancet. 2019;394(10215):2165–2172. doi: 10.1016/S0140-6736(19)32515-2Whelan T.J., Julian J.A., Berrang T.S., et al. External beam accelerated partial breast irradiation versus whole breast irradiation after breast conserving surgery in women with ductal carcinoma in situ and node-negative breast cancer (RAPID): a randomised controlled trial // Lancet. 2019. Vol. 394, N 10215. P. 2165–2172. doi: 10.1016/S0140-6736(19)32515-233.Vicini FA, Cecchini RS, White JR, et al. Long-term primary results of accelerated partial breast irradiation after breast-conserving surgery for early-stage breast cancer: a randomised, phase 3, equivalence trial. Lancet. 2019;394(10215):2155–2164. doi: 10.1016/S0140-6736(19)32514-0Vicini F.A., Cecchini R.S., White J.R., et al. Long-term primary results of accelerated partial breast irradiation after breast-conserving surgery for early-stage breast cancer: a randomised, phase 3, equivalence trial // Lancet. 2019. Vol. 394, N 10215. P. 2155–2164. doi: 10.1016/S0140-6736(19)32514-034.Whelan TJ, Olivotto IA, Parulekar WR, et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med. 2015;373(4):307–316. doi: 10.1056/NEJMoa1415340Whelan T.J., Olivotto I.A., Parulekar W.R., et al. Regional nodal irradiation in early-stage breast cancer // N Engl J Med. 2015. Vol. 373, N 4. P. 307–316. doi: 10.1056/NEJMoa141534035.Kim YB, Byun HK, Kim DY, et al. Effect of elective internal mammary node irradiation on disease-free survival in women with node-positive breast cancer: a randomized phase 3 clinical trial. JAMA Oncol. 2022;8(1):96–105. doi: 10.1001/jamaoncol.2021.6036Kim Y.B., Byun H.K., Kim D.Y., et al. Effect of elective internal mammary node irradiation on disease-free survival in women with node-positive breast cancer: a randomized phase 3 clinical trial // JAMA Oncol. 2022. Vol. 8, N 1. P. 96–105. doi: 10.1001/jamaoncol.2021.603636.Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Radiotherapy to regional nodes in early breast cancer: an individual patient data meta-analysis of 14 324 women in 16 trials. Lancet. 2023;402(10416):1991–2003. doi: 10.1016/S0140-6736(23)01082-6Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Radiotherapy to regional nodes in early breast cancer: an individual patient data meta-analysis of 14 324 women in 16 trials // Lancet. 2023. Vol. 402, N 10416. P. 1991–2003. doi: 10.1016/S0140-6736(23)01082-637.Wang J, Shi M, Ling R, et al. Adjuvant chemotherapy and radiotherapy in triple-negative breast carcinoma: a prospective randomized controlled multi-center trial. Radiother Oncol. 2011;100(2):200–204. doi: 10.1016/j.radonc.2011.07.007Wang J., Shi M., Ling R., et al. Adjuvant chemotherapy and radiotherapy in triple-negative breast carcinoma: a prospective randomized controlled multi-center trial // Radiother Oncol. 2011. Vol. 100, N 2. P. 200–204. doi: 10.1016/j.radonc.2011.07.00738.Haque W, Verma V, Farach A, et al. Postmastectomy radiation therapy for triple negative, node-negative breast cancer. Radiother Oncol. 2019;132:48–54. doi: 10.1016/j.radonc.2018.11.012Haque W., Verma V., Farach A., et al. Postmastectomy radiation therapy for triple negative, node-negative breast cancer // Radiother Oncol. 2019. Vol. 132. P. 48–54. doi: 10.1016/j.radonc.2018.11.01239.Gillon P, Touati N, Breton-Callu C, et al. Factors predictive of loco regional recurrence following neoadjuvant chemotherapy in patients with large operable or locally advanced breast cancer: An analysis of the EORTC 10994/BIG 1-00 study. Eur J Cancer. 2017;79:226–234. doi: 10.1016/j.ejca.2017.04.012Gillon P., Touati N., Breton-Callu C., et al. Factors predictive of locoregional recurrence following neoadjuvant chemotherapy in patients with large operable or locally advanced breast cancer: An analysis of the EORTC 10994/BIG 1-00 study // Eur J Cancer. 2017. Vol. 79. P. 226–234. doi: 10.1016/j.ejca.2017.04.01240.Caudle AS, Yu TK, Tucker SL, et al. Local-regional control according to surrogate markers of breast cancer subtypes and response to neoadjuvant chemotherapy in breast cancer patients undergoing breast conserving therapy. Breast Cancer Res. 2012;14(3):R83. doi: 10.1186/bcr3198Caudle A.S., Yu T.K., Tucker S.L., et al. Local-regional control according to surrogate markers of breast cancer subtypes and response to neoadjuvant chemotherapy in breast cancer patients undergoing breast conserving therapy // Breast Cancer Res. 2012. Vol. 14, N 3. P. 83. doi: 10.1186/bcr319841.Haffty BG, McCall LM, Ballman KV, et al. Impact of radiation on locoregional control in women with node-positive breast cancer treated with neoadjuvant chemotherapy and axillary lymph node dissection: results from ACOSOG Z1071 clinical trial. Int J Radiat Oncol Biol Phys. 2019;105(1):174–182. doi: 10.1016/j.ijrobp.2019.04.038Haffty B.G., McCall L.M., Ballman K.V., et al. Impact of radiation on locoregional control in women with node-positive breast cancer treated with neoadjuvant chemotherapy and axillary lymph node dissection: results from ACOSOG Z1071 clinical trial // Int J Radiat Oncol Biol Phys. 2019. Vol. 105, N 1. P. 174–182. doi: 10.1016/j.ijrobp.2019.04.03842.Crown A, Gonen M, Le T, Morrow M. Does failure to achieve pathologic complete response with neoadjuvant chemotherapy identify node-negative patients who would benefit from postmastectomy radiation or regional nodal irradiation? Ann Surg Oncol. 2021;28(3):1328–1335. doi: 10.1245/s10434-020-09136-8Crown A., Gonen M., Le T., Morrow M. Does failure to achieve pathologic complete response with neoadjuvant chemotherapy identify node-negative patients who would benefit from postmastectomy radiation or regional nodal irradiation? // Ann Surg Oncol. 2021. Vol. 28, N 3. P. 1328–1335. doi: 10.1245/s10434-020-09136-843.Cortazar P, Zhang L, Untch M, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164–172. doi: 10.1016/S0140-6736(13)62422-8Cortazar P., Zhang L., Untch M., et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis // Lancet. 2014. Vol. 384, N 9938. P. 164–172. doi: 10.1016/S0140-6736(13)62422-844.Spring LM, Fell G, Arfe A, et al. Pathologic complete response after neoadjuvant chemotherapy and impact on breast cancer recurrence and survival: a comprehensive meta-analysis. Clin Cancer Res. 2020;26(12):2838–2848. doi: 10.1158/1078-0432.CCR-19-3492Spring L.M., Fell G., Arfe A., et al. Pathologic complete response after neoadjuvant chemotherapy and impact on breast cancer recurrence and survival: a comprehensive meta-analysis // Clin Cancer Res. 2020. Vol. 26, N 12. P. 2838–2848. doi: 10.1158/1078-0432.CCR-19-349245.Kayali M, Abi Jaoude J, Tfayli A, et al. Post-mastectomy radiation therapy in breast cancer patients with 1-3 positive lymph nodes: No one size fits all. Crit Rev Oncol Hematol. 2020;147:102880. doi: 10.1016/j.critrevonc.2020.102880Kayali M., Abi Jaoude J., Tfayli A., et al. Post-mastectomy radiation therapy in breast cancer patients with 1-3 positive lymph nodes: No one size fits all // Crit Rev Oncol Hematol. 2020. Vol. 147. P. 102880. doi: 10.1016/j.critrevonc.2020.10288046.Mamounas E, Bandos H, White J, et al. Loco-Regional Irradiation in patients with biopsyproven axillary node involvement at Presentation who become pathologically node-negative after Neoadjuvant Chemotherapy: primary outcomes of NRG Oncology/NSABP B-51/RTOG 1304.2023. Cancer Res. 2024;84(9_Suppl):GS02-07-GS02-07 doi: 10.1158/1538-7445.sabcs23-gs02-07Mamounas E., Bandos H., White J., et al. Loco-regional irradiation in patients with biopsyproven axillary node involvement at Presentation who become pathologically node-negative after neoadjuvant chemotherapy: primary outcomes of NRG Oncology/NSABP B-51/RTOG 1304.2023 // Cancer Res. 2024. Vol. 84, N 9_Suppl. P. GS02-07-GS02-07 doi: 10.1158/1538-7445.sabcs23-gs02-0747.Jamora K, Cruz-Lim EM, Cereno RE, et al. Hypofractionated radiotherapy in postmastectomy locally advanced breast cancer: an interim report on acute toxicities and dosimetry. Rep Pract Oncol Radiother. 2022;27(6):943–953. doi: 10.5603/RPOR.a2022.0102Jamora K., Cruz-Lim E.M., Cereno R.E., et al. Hypofractionated radiotherapy in postmastectomy locally advanced breast cancer: an interim report on acute toxicities and dosimetry // Rep Pract Oncol Radiother. 2022. Vol. 27, N 6. P. 943–953. doi: 10.5603/RPOR.a2022.010248.Wong JS, Uno H, Tramontano AC, et al. Hypofractionated vs conventionally fractionated postmastectomy radiation after implant-based reconstruction: a randomized clinical trial. JAMA Oncol. 2024;10(10):1370–1378. doi: 10.1001/jamaoncol.2024.2652Wong J.S., Uno H., Tramontano A.C., et al. Hypofractionated vs conventionally fractionated postmastectomy radiation after implant-based reconstruction: a randomized clinical trial // JAMA Oncol. 2024. Vol. 10, N 10. P. 1370–1378. doi: 10.1001/jamaoncol.2024.265249.Ahmed KA, Liveringhouse CL, Mills MN, et al. Utilizing the genomically adjusted radiation dose (GARD) to personalize adjuvant radiotherapy in triple negative breast cancer management. EBioMedicine. 2019;47:163–169. doi: 10.1016/j.ebiom.2019.08.019Ahmed K.A., Liveringhouse C.L., Mills M.N., et al. Utilizing the genomically adjusted radiation dose (GARD) to personalize adjuvant radiotherapy in triple negative breast cancer management // EBioMedicine. 2019. Vol. 47. P. 163–169. doi: 10.1016/j.ebiom.2019.08.01950.Masuda N, Lee SJ, Ohtani S, et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Engl J Med. 2017;376(22):2147–2159. doi: 10.1056/NEJMoa1612645Masuda N., Lee S.J., Ohtani S., et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy // N Engl J Med. 2017. Vol. 376, N 22. P. 2147–2159. doi: 10.1056/NEJMoa161264551.Woodward WA, Fang P, Arriaga L, et al. A phase 2 study of capecitabine and concomitant radiation in women with advanced breast cancer. Int J Radiat Oncol Biol Phys. 2017;99(4):777–783. doi: 10.1016/j.ijrobp.2017.04.030Woodward W.A., Fang P., Arriaga L., et al. A phase 2 study of capecitabine and concomitant radiation in women with advanced breast cancer // Int J Radiat Oncol Biol Phys. 2017. Vol. 99, N 4. P. 777–783. doi: 10.1016/j.ijrobp.2017.04.03052.Schmid P, Cortes J, Dent R, et al. Event-free survival with pembrolizumab in early triple-negative breast cancer. N Engl J Med. 2022;386(6):556–567. doi: 10.1056/NEJMoa2112651Schmid P., Cortes J., Dent R., et al. Event-free Survival with Pembrolizumab in Early Triple-Negative Breast Cancer // N Engl J Med. 2022. Vol. 386, N 6. P. 556–567. doi: 10.1056/NEJMoa211265153.Tison T, Loap P, Arnaud E, et al. Tolerance of concurrent adjuvant radiation therapy and pembrolizumab for triple negative breast cancer: real life experience. Adv Radiat Oncol. 2023;9(3):101384. doi: 10.1016/j.adro.2023.101384Tison T., Loap P., Arnaud E., et al. Tolerance of concurrent adjuvant radiation therapy and pembrolizumab for triple negative breast cancer: real life experience // Adv Radiat Oncol. 2023. Vol. 9, N 3. P. 101384. doi: 10.1016/j.adro.2023.10138454.Voorwerk L, Slagter M, Horlings HM, et al. Immune induction strategies in metastatic triple-negative breast cancer to enhance the sensitivity to PD-1 blockade: the TONIC trial. Nat Med. 2019;25(6):920–928. doi: 10.1038/s41591-019-0432-4Voorwerk L., Slagter M., Horlings H.M., et al. Immune induction strategies in metastatic triple-negative breast cancer to enhance the sensitivity to PD-1 blockade: the TONIC trial // Nat Med. 2019. Vol. 25, N 6. P. 920–928. doi: 10.1038/s41591-019-0432-455.Geyer CE Jr, Garber JE, Gelber RD, et al. Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high-risk, early breast cancer. Ann Oncol. 2022;33(12):1250–1268. doi: 10.1016/j.annonc.2022.09.159Geyer C.E. Jr., Garber J.E., Gelber R.D., et al. Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high-risk, early breast cancer // Ann Oncol. 2022. Vol. 33, N 12. P. 1250–1268. doi: 10.1016/j.annonc.2022.09.15956.Jagsi R, Griffith KA, Bellon JR, et al. Concurrent veliparib with chest wall and nodal radiotherapy in patients with inflammatory or loco regionally recurrent breast cancer: The TBCRC 024 phase I multicenter study. J Clin Oncol. 2018;36(13):1317–1322. doi: 10.1200/JCO.2017.77.2665Jagsi R., Griffith K.A., Bellon J.R., et al. Concurrent veliparib with chest wall and nodal radiotherapy in patients with inflammatory or loco regionally recurrent breast cancer: The TBCRC 024 Phase I Multicenter Study // J Clin Oncol. 2018. Vol. 36, N 13. P. 1317–1322. doi: 10.1200/JCO.2017.77.266557.Loap P, Loirat D, Berger F, et al. concurrent olaparib and radiotherapy in patients with triple-negative breast cancer: the phase 1 olaparib and radiation therapy for triple-negative breast cancer trial. JAMA Oncol. 2022;8(12):1802–1808. doi: 10.1001/jamaoncol.2022.5074Loap P., Loirat D., Berger F., et al. Concurrent olaparib and radiotherapy in patients with triple-negative breast cancer: the phase 1 olaparib and radiation therapy for triple-negative breast cancer trial // JAMA Oncol. 2022. Vol. 8, N 12. P. 1802–1808. doi: 10.1001/jamaoncol.2022.507458.Chmura SJ. NRG-BR002: A phase IIR/III trial of standard of care systemic therapy with or without stereotactic body radiotherapy (SBRT) and/or surgical resection (SR) for newly oligometastatic breast cancer. J Clin Oncol. 2022;40 Supl 16:1007. doi: 10.1200/JCO.2022.40.16_suppl.1007Chmura S.J. NRG-BR002: A phase IIR/III trial of standard of care systemic therapy with or without stereotactic body radiotherapy (SBRT) and/or surgical resection (SR) for newly oligometastatic breast cancer // J Clin Oncol. 2022. Vol. 40 Supl 16. P. 1007. doi: 10.1200/JCO.2022.40.16_suppl.100759.Schaverien MV, Singh P, Smith BD, et al. Premastectomy radiotherapy and immediate breast reconstruction: a randomized clinical trial. JAMA Netw Open. 2024;7(4):e245217. doi: 10.1001/jamanetworkopen.2024.5217Schaverien M.V., Singh P., Smith B.D., et al. Premastectomy radiotherapy and immediate breast reconstruction: a randomized clinical trial // JAMA Netw Open. 2024. Vol. 7, N 4. P. e245217. doi: 10.1001/jamanetworkopen.2024.521760.Meattini I, Francolini G, Di Cataldo V, et al. Preoperative robotic radiosurgery for early breast cancer: Results of the phase II ROCK trial (NCT03520894). Clin Transl Radiat Oncol. 2022;37:94–100. doi: 10.1016/j.ctro.2022.09.004Meattini I., Francolini G., Di Cataldo V., et al. Preoperative robotic radiosurgery for early breast cancer: Results of the phase II ROCK trial (NCT03520894) // Clin Transl Radiat Oncol. 2022. Vol. 37. P. 94–100. doi: 10.1016/j.ctro.2022.09.00461.Civil YA, Jonker LW, Groot Koerkamp MPM, et al. Preoperative partial breast irradiation in patients with low-risk breast cancer: a systematic review of literature. Ann Surg Oncol. 2023;30(6):3263–3279. doi: 10.1245/s10434-023-13233-9Civil Y.A., Jonker L.W., Groot Koerkamp M.P.M., et al. Preoperative partial breast irradiation in patients with low-risk breast cancer: a systematic review of literature // Ann Surg Oncol. 2023. Vol. 30, N 6. P. 3263–3279. doi: 10.1245/s10434-023-13233-962.Kuerer HM, Smith BD, Krishnamurthy S, et al. Eliminating breast surgery for invasive breast cancer in exceptional responders to neoadjuvant systemic therapy: a multicentre, single-arm, phase 2 trial. Lancet Oncol. 2022;23(12):1517–1524. doi: 10.1016/S1470-2045(22)00613-1Kuerer H.M., Smith B.D., Krishnamurthy S., et al. Eliminating breast surgery for invasive breast cancer in exceptional responders to neoadjuvant systemic therapy: a multicentre, single-arm, phase 2 trial // Lancet Oncol. 2022. Vol. 23, N 12. P. 1517–1524. doi: 10.1016/S1470-2045(22)00613-1