Breast-Directed Palliative Radiotherapy in Metastatic and Inoperable Locally Advanced Breast Cancer: From Clinical Efficacy to Psychosocial Impact

Purpose of Review As advances in systemic therapy and radiotherapy (RT) change the landscape of breast cancer management, the role and optimal approach for palliative treatment has similarly evolved. In this review, we will discuss current indications, clinical and psychosocial benefits, and modern strategies for the use of breast-directed palliative RT for patients with metastatic and inoperable locally advanced breast cancer. Recent Findings Breast-directed palliative RT options include standard palliative regimens as well as dose-escalated hypofractionated approaches. Overall clinical response rates approach 90% across regimens, with treatment durability increasing with higher total effective dose delivered. Grade ≥ 3 toxicities are rare, even in the context of retreatment, and psychosocial and quality of life outcomes generally improve after palliative RT. Summary Palliative RT is the preferred strategy for symptomatic breast disease in metastatic or inoperative locally advanced breast cancer, with increasing durability with modern approaches. Future studies should define optimal dose, fractionation, and treatment selection factors.