Breast cancer stands as the most prevalent malignancy among women, with radiotherapy serving as a primary treatment modality. Despite radiotherapy, a subset of breast cancer patients experiences local recurrence, attributed to the intrinsic resistance of tumors to radiation. Therefore, there is a compelling need to explore novel approaches that can enhance cytotoxic effects through alternative mechanisms. Traditional Chinese Medicine (TCM) and its active constituents exhibit diverse pharmacological actions, including anti-tumor effects, offering extensive possibilities to identify effective components capable of overcoming radiotherapy resistance. This review delineates the mechanisms underlying radiotherapy resistance in breast cancer, along with potential candidate Chinese herbal medicines that may sensitize breast cancer cells to radiotherapy. The exploration of such herbal interventions holds promise for improving therapeutic outcomes in the context of breast cancer radiotherapy resistance.

Purpose The administration of immune checkpoint inhibitors (ICIs) may lead to renal adverse events, notably including renal dysfunction. To early predict the probability of renal dysfunction after ICIs therapy, a retrospective case–control study was conducted. Methods Clinical information on ICIs-treated patients was collected. Multivariable logistic regression was applied to identify risk factors for renal dysfunction after ICIs treatment. Moreover, a nomogram model was developed and validated internally. Results A total of 442 patients were included, among which 35 (7.9%) experienced renal dysfunction after ICIs treatment. Lower baseline estimated glomerular filtration rate (eGFR) (OR 0.941; 95% CI 0.917 to 0.966; p<0.001), concurrent exposure of platinum(OR 4.014; 95% CI 1.557 to 10.346; p=0.004), comorbidities of hypertension (OR 3.478; 95% CI 1.600 to 7.562; p=0.002) and infection (OR 5.402; 95% CI 1.544 to 18.904; p=0.008) were found to be independent associated with renal dysfunction after ICIs treatment. To develop a predictive nomogram for the occurrence of renal dysfunction after ICIs treatment, the included cases were divided into training and validation groups in a ratio of 7:3 randomly. The above four independent risk factors were included in the model. The area under the receiver operating characteristic curves of the predictiive model were 0.822 (0.723–0.922) and 0.815 (0.699–0.930) in the training and validation groups, respectively. Conclusions Lower baseline eGFR, platinum exposure, comorbidities of hypertension and infection were predictors of renal dysfunction in ICIs-treated patients with cancer. A nomogram was developed to predict the probability of renal dysfunction after ICIs treatment, which might be operable and valuable in clinical practice.

Introduction Postoperative radiotherapy in patients with breast cancer with one to three lymph node metastases, particularly within the pT1–2N1M0 cohort with a low clinical risk of local–regional recurrence (LRR), has incited a discourse surrounding personalised treatment strategies. Multigene testing for Recurrence Index (RecurIndex) model capably differentiates patients based on their level of LRR risk. This research aims to validate whether a more aggressive treatment approach can enhance clinical outcomes in N1 patients who possess a clinically low risk of LRR, yet a high RecurIndex-determined risk of LRR. Specifically, this entails postoperative whole breast irradiation combined with regional lymph node irradiation (RNI) following breast-conserving surgery or chest wall irradiation with RNI after mastectomy. Methods and analysis The RIGAIN (RecurIndex-Guided postoperative radiotherapy with or without Avoidance of Irradiation of regional Nodes in 1–3 node-positive breast cancer) Study is a multicentre, prospective, randomised, open-label, phase III clinical trial that is being conducted in China. In this study, patients with low clinical LRR risk but high RecurIndex-LRR risk are randomly assigned in a 1:1 ratio to the experimental group or the control group. In the experimental group, RNI is performed and the control group omits RNI. Efficacy and safety analyses will be conducted, enrolling a total of 540 patients (270 per group). The primary endpoint is invasive disease-free survival, and secondary endpoints include any first recurrence, LRR-free survival, distant metastasis-free survival, recurrence-free survival, overall survival, disease-free survival, breast cancer-specific mortality and assessment of patient quality of life. The study began in April 2023 and with a follow-up period of 60 months after the last participant completes radiation therapy. Ethics and dissemination The study was approved by the Ethics Committee of Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University (SYSKY-2022-097-02, V.3.1). It adheres to the Helsinki Declaration and Good Clinical Practice. Research findings will be submitted for publication in peer-reviewed journals. Trial registration number NCT04069884.

Breast cancer remains the most prevalent malignancy among women, and radiotherapy plays a pivotal role in reducing local recurrence and improving prognosis. However, the emergence of radioresistance in a subset of patients significantly compromises treatment efficacy, underscoring the need for a deeper understanding of the underlying molecular mechanisms. In recent years, non‐coding RNAs (ncRNAs) have emerged as key regulators of gene expression and have garnered increasing attention for their roles in mediating radioresistance in breast cancer. This review systematically summarises the major molecular mechanisms by which ncRNAs contribute to breast cancer radioresistance, including cell cycle regulation, DNA damage repair, programmed cell death (e.g., apoptosis, autophagy and ferroptosis), oxidative stress response, tumour microenvironment remodelling and maintenance of cancer stem cell properties. On the translational front, RNA‐based therapeutic approaches—including antisense oligonucleotides (ASOs), small interfering RNAs (siRNAs), miRNA mimics and CRISPR/Cas9—offer promising avenues for radiosensitisation, yet face substantial clinical hurdles. These include immune activation, poor delivery specificity, intracellular trafficking barriers and limited stability. Advances in chemical modifications and nanoparticle‐based delivery systems—such as redox‐responsive nanocarriers—have shown potential in enhancing the efficacy and safety of ncRNA‐targeted therapies. Despite encouraging progress, clinical translation remains constrained by a lack of methodological standardisation, insufficient high‐quality clinical data, limited biomarker reliability, suboptimal target selection and unresolved safety concerns. Future efforts should prioritise optimisation of delivery platforms, validation of multi‐ncRNA biomarker panels in large, multicentre cohorts and integration of multi‐omics data to reconstruct comprehensive regulatory networks, ultimately accelerating the clinical deployment of ncRNA‐based radiosensitisation strategies.

Breast cancer is the most commonly diagnosed cancer in women globally (1). The estimated numbers of breast cancer cases account for 32% of all new diagnoses for women in the United States in 2024 (2). Radiotherapy is an important component of breast cancer therapy. Adjuvant radiotherapy is the standard of care for patients receiving breast-conserving surgery, which can significantly reduce locoregional recurrence and the breast cancer death rate (3). Regional node radiotherapy in early breast cancer patients significantly reduced breast cancer mortality and all-cause mortality in trials done in recent years (4). However, the development of radioresistance remains a major challenge in improving outcomes for breast cancer patients who receive radiotherapy (5). This research topic aims to explore the mechanisms of radioresistance and find promising predictive and therapeutic methods for radioresistant breast cancer patients. 8 articles were accepted. Screening of radioresistant breast cancer patients is important for improving the effect of radiotherapy. In this topic, Zhang et al. proposed a novel radiotherapy response classification system based upon molecular profiles for estimating radiosensitivity for individual breast cancer patients and elucidated a methodological advancement for the synergy of radiotherapy with immune checkpoint blockade (ICB). This study classified breast cancer patients to radiotherapy-sensitive and radiotherapy-resistant clusters by quantitative RT-PCR analyses of differentially expressed radiotherapy response-related genes (DERRGs). Then, the Riskscore was proposed to improve patient prognosis. The high Riskscore samples had lower radiotherapeutic response and stronger DNA damage repair as well as poor anticancer immunity. Zheng et al. found that a higher Nottingham prognostic index (NPI) score is an independent risk factor for predicting locoregional recurrence in breast cancer. Two nomogram prediction models related to radioresistance were constructed in this study. Six significant variables were identified for the models, including age, body mass index (BMI), TNM stage, NPI, vascular invasion, and perineural invasion. The nomogram prediction model based on the NPI has undergone internal validation and has been found to have good discrimination and calibration. The two studies highlight the importance of identifying radioresistant breast cancer patients through different clinical variables and special radiotherapy response-related genes.The de-escalation of radiotherapy for selected breast cancer patients is also important for overcoming radioresistance. Because prolonged radiation therapy is more likely to induce secondary radioresistance. Liu et al. conducted a retrospective analysis and found that omitting regional lymph node irradiation may be a safe option in T1-2N1 HER2-overexpressing by breast cancer patients receiving standardized anti-HER2 targeted therapy, particularly in ER-positive or lymph vascular invasion status (LVI)-negative subgroups. The strategies of de-escalated radiotherapy in target volume are also researched for breast cancer patients. The European Society for Radiotherapy and Oncology–Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) updated a new target volume delineation guideline for postmastectomy radiotherapy after implant-based reconstruction. Park et al. aimed to evaluate the impact on breast complications with the new guideline compared to the conventional guidelines, and found that the new ESTRO-ACROP target volume guideline did not demonstrate significant differences in major or any breast complications compared to the conventional guidelines. It showed a tendency to reduce complication risks by the volume de-escalation of radiotherapy.Tumor volume and radiation dose are predictors of response and can be used to guide the decision-making for patients with radioresistant brain metastases (6). Stereotactic radiosurgery offers a benefit over whole-brain radiation, which is attributed to the reduction of radioresistance and neurotoxicity (7). Li et al. conducted a retrospective analysis to study the role of brain radiotherapy in HER2-positive breast cancer with brain metastases. Because it is considered that with the development of HER2-targeted therapies, brain radiotherapy can be delayed, and stereotactic radiosurgery (SRS) can be used in more patients. The authors concluded that HER2-positive breast cancer with brain metastases still faces significant challenges, particularly those with high intracranial tumor burden, which correlates with poorer outcomes and higher incidence of leptomeningeal metastasis. Larger tumors necessitated more comprehensive treatment approaches, such as whole-brain radiation therapy (WBRT) and SRS. And the target tumor volume and dose of intraoperative radiotherapy (IORT) are also much smaller than conventional radiation. Bhimani et al. demonstrate the successful use of IORT for breast-conserving surgery in patients with bilateral breast cancer (BBC) by their case series. The authors concluded that IORT may serve as an excellent patient-centered alternative for BBC, considering the benefits of improved patient compliance and a reduced number of multiple visits.HER2-targeting monoclonal antibodies can be combined with radiation in breast cancer, apparently with no excess toxicities (8). The developments of antibody-drug conjugate (ADC) offer an opportunity for the use of radiotherapy in refractory breast cancer. Gui et al. conducted a disproportionality analysis using spontaneous reports in the FDA adverse event reporting system to assess the real-world safety concerns of Sacituzumab Govitecan (SG). SG is a novel ADC that is a trophoblastic cell surface antigen-2 (TROP-2) directed antibody conjugated to the active metabolite of irinotecan, SN-38 (govitecan). This study provides crucial real-world safety data on SG, complementing existing clinical trial information. The...

Early identification and timely intervention of radiotherapy‑related toxicities are crucial for maintaining treatment adherence and improving quality of life in patients with head and neck cancer (HNC) undergoing concurrent chemoradiotherapy (CCRT). To address this clinical need, a nurse‑led smartphone application, Sun Yat-sen Symptom Management (SYS-SM), was developed to integrate patient‑reported outcome (PRO) assessments with personalized self‑management guidance tailored to individual symptom profiles. The feasibility and preliminary efficacy of this application were evaluated in a randomized controlled trial (RCT). Eligible patients were randomly assigned to an intervention group or a control group. During the 3-month intervention period, the intervention group received standard care combined with nurse-led personalized mobile symptom management, whereas the control group received standard care alone. The intervention included in-person discharge education, structured instruction on application use, and automated push notifications delivering individualized health management recommendations based on PRO data. When symptom scores exceeded predefined thresholds, alerts were automatically generated for nursing staff. Clinical outcomes were assessed at baseline (T0), 1 month (T1), and 3 months (T2). A total of 136 patients were enrolled (107 [78.7%] men; mean [SD] age, 50.88 [12.6] years), including 67 participants in the intervention group and 69 in the control group, with no significant differences in baseline characteristics. For health-related quality of life (HRQOL), the primary summary scores showed no significant overall group × time interaction (P = 0.108; T2: mean difference [MD] = 4.61; 95% CI, -1.02-10.24; effect size [ES] = 0.23). In the physical functioning domain demonstrated a significant interaction effect (P = 0.048; T2: MD = 8.25; 95% CI, 1.15-15.35), its effect size (ES = 0.35) remained below the clinical threshold (ES ≥ 0.40). Notably, significant improvements were observed in several secondary domains, specifically appetite loss (interaction P = 0.001; ES = -0.56) and global health status (interaction P = 0.009; ES = 0.46). Improvements in self-efficacy (SUPPH interaction P = 0.012) and psychological status (IDA interaction P < 0.01) were significantly greater in the intervention group. The SYS-SM application demonstrated high feasibility and acceptability. A nurse-led personalized mobile health symptom management intervention did not significantly improve primary overall HRQOL summary scores, but it demonstrated targeted benefits in reducing specific symptoms (particularly appetite loss), enhancing self-management capacity, and alleviating negative affect in patients with HNC undergoing concurrent chemoradiotherapy. The application shows potential for broader clinical implementation. The study was prospectively registered with the Chinese Clinical Trial Registry (ChiCTR2300072314) on June 9, 2023.