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Artificial intelligence in breast cancer radiotherapy: Insights from the Toolbox Consortium Delphi study

Kaidar-Person, O.
Pfob, A.
Valentini, V.
Aznar, M.
Dekker, A.
Meattini, I.
de Boniface, J.
Krug, D.
Cardoso, M. J.
Curigliano, G.
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Abstract
Artificial intelligence (AI) is being incorporated in several breast cancer care domains, including for radiation therapy (RT). Herein we provide a review about AI for the management and planning of RT for breast cancer, which is part of the Toolbox-3 project's multidisciplinary Delphi study, including a literature review of studies related to the topic raised by the Delphi questionnaire. Our review shows that available evidence mainly consists of small single institutional studies, often at least partly supported by commercial companies. Current studies suffer from a lack of transparency regarding how these systems were developed, the information they are based on, the algorithms used, and potential proprietary issues. This review provides a critical inter- and multidisciplinary assessment of existing systems to help us in guiding development and utilisation of AI-based tools in the field of radiation oncology. As medical professional users, we must remain vigilant and continue to improve our personal experience and knowledge that serves as the 'ground truth'. Employing AI required a critical mindset, particularly in medical applications which may influence the lives of our patients.
Affiliation
Breast Radiation Unit, Sheba Tel Hashomer, Ramat Gan, Israel; Gray School of Medical Sciences, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: orit.kaidarperson@sheba.health.gov.il. Breast Center Heidelberg, Hospital St. Elisabeth, Heidelberg, Germany; Department of Obstetrics & Gynecology, Heidelberg University Hospital, Heidelberg, Germany. Centro Eccellenza Oncologia e Diagnostica per Immagini, Ospedale Isola Tiberina - Gemelli Isola, Roma, Italy. Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands. Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi-University of Florence, Florence, Italy. Department of Surgery, Capio St. Göran's Hospital, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf AND Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany. Breast Cancer Research Program, Champalimaud Foundation and Lisbon University Faculty of Medicine, Portugal. European Institute of Oncology, IRCCS, Milano, Italy; University of Milano, Milano, Italy. Breast Centre, Hirslanden Klinik St. Anna, Luzern, Switzerland; University of Lucerne, Department of Health Sciences and Medicine, Luzern, Switzerland. Department of Radiation Oncology, Iridium Netwerk, Wilrijk-Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium.
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2025
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Article
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Kaidar-Person O, Pfob A, Valentini V, Aznar M, Dekker A, Meattini I, et al. Artificial intelligence in breast cancer radiotherapy: Insights from the Toolbox Consortium Delphi study. Breast (Edinburgh, Scotland). 2025 Oct;83:104537. PubMed PMID: 40763489. Pubmed Central PMCID: PMC12341621. Epub 2025/08/06. eng.
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