Current PerspectivePreoperative breast radiation therapy: Indications and perspectives

•Preoperative breast radiation therapy (RT) is being investigated in current trials.•RT could potentially downstage larger hormone receptor positive breast cancers.•Delivering RT before mastectomy and reconstruction may avoid sequencing difficulties.•Preoperative partial breast irradiation could be advantageous to cosmetic outcome.•Preoperative RT enables translational research included in current trial protocols.

Preoperative breast radiation therapy (RT) is not a new concept, but older studies failed to change practice. More recently, there has been interest in revisiting preoperative RT using modern techniques. This current perspective discusses the indications, summarises the published literature and then highlights current clinical trials, with particular attention to combining with novel drugs and optimising associated translational research.