Table 4 Advantages and disadvantages of preoperative PBI. [32]

Better localization of the irradiated area, better visibility of the primary tumor—possibility to insert tracers near the tumor during biopsy of the lesion, which minimizes the risk of geographic error;

Possible tumor down-staging and increased rates of breast-conserving surgery;

Preoperative radiotherapy reduces the problem of the possible technical treatment planning challenges after oncoplastic surgery

Reduction in irradiated area and associated reduction in toxicity. With preoperative radiation therapy, we irradiate the tumor volume with a margin. Surgery is performed after radiation therapy, so the area of the breast receiving the highest dose of radiation is removed, which can lead to limited fibrosis and good cosmetic outcomes;

Better oxygenation of tumor tissues which determines a better therapeutic effect of radiotherapy than in tissues undergoing surgical intervention;

In favorable cases of breast cancer, postoperative WBRT may be omitted if preoperative PBI has been applied. Generation of an abscopal effect, which is not the case with postoperative radiotherapy;

o Reduction in number of radiotherapy sessions

Possible delay in performing surgery due the duration or complications after radiation therapy-this problem does not apply to stereotactic radiation therapy performed in the shortest possible time,

Upstaging of the tumor, positive margins after surgery, changing the receptor profile to a less favorable one which requires more aggressive treatment regimens like: irradiating the whole breast, nodal areas or chemotherapy