{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T16:11:28Z","timestamp":1788883888971,"version":"build-2803163510"},"reference-count":40,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Radioresistance remains a critical barrier to achieving durable locoregional control and improved survival outcomes in breast cancer. RAD18, an E3 ubiquitin ligase that regulates translesion synthesis and post-replication repair, has emerged as a candidate mediator of this phenotype by promoting proliferating cell nuclear antigen (PCNA) ubiquitination, facilitating replication stress tolerance, and enabling tumor cell survival following DNA damage. In parallel, the PI3K\/AKT\/mTOR (PAM) signaling pathway represents one of the most frequently dysregulated oncogenic networks in breast cancer and is increasingly recognized as a central determinant of therapeutic resistance. Notably, however, its biological and clinical relevance is highly context-dependent, with the strongest evidence observed in hormone receptor\u2013positive (HR+)\/HER2-negative disease and a more heterogeneous, less well-defined role in triple-negative breast cancer. In this narrative review, we integrate current evidence to examine the role of RAD18 in breast cancer radioresistance and to evaluate how RAD18-mediated DNA damage tolerance may be functionally embedded within broader PAM-driven survival programs. While existing data support a biologically plausible convergence between DNA damage tolerance mechanisms and oncogenic survival signaling, direct mechanistic evidence linking RAD18 to PAM pathway activity in breast cancer remains limited. We therefore propose a subtype-informed conceptual framework in which RAD18-dependent stress tolerance operates within a permissive survival signaling context. Such a framework may refine the interpretation of radioresistance and inform the development of predictive biomarkers as well as rational radiosensitization strategies.<\/jats:p>","DOI":"10.1515\/biol-2025-1356","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T15:56:41Z","timestamp":1788883001000},"source":"Crossref","is-referenced-by-count":0,"title":["Progress for RAD18\u2019s mechanism in breast cancer radioresistant"],"prefix":"10.1515","volume":"21","author":[{"given":"Yiming","family":"Zhao","sequence":"first","affiliation":[{"name":"School of Clinical Medicine, Shandong Second Medical University , Weifang 261053 , China"},{"name":"Department of Oncology , Zibo Central Hospital , Zibo 255020 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanhua","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Oncology , Zibo Central Hospital , Zibo 255020 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3003-3627","authenticated-orcid":false,"given":"Yiyang","family":"Yu","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Shandong Second Medical University , Weifang 261053 , China"},{"name":"Department of Oncology , Zibo Central Hospital , Zibo 255020 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Oncology , Zibo Central Hospital , Zibo 255020 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanbin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery , Zibo Key Laboratory of Breast Cancer Individualized Diagnosis, Treatment and Transformation, Zibo Central Hospital , Zibo 255020 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"2026090815561564114_j_biol-2025-1356_ref_001","unstructured":"The Breast Cancer Professional Committee of the Chinese Anti-Cancer Association and the Breast Oncology Group of the Oncology Branch of the Chinese Medical Association. \u201cGuidelines and specifications for the diagnosis and treatment of breast cancer\u201d of the Chinese Anti-Cancer Association (2026 Edition). Chin J Cancer 2025;35:1157\u2013255."},{"key":"2026090815561564114_j_biol-2025-1356_ref_002","doi-asserted-by":"crossref","unstructured":"Costin, IC, Marcu, LG. Factors impacting on patient setup analysis and error management during breast cancer radiotherapy. Crit Rev Oncol Hematol 2022;178:103798. https:\/\/doi.org\/10.1016\/j.critrevonc.2022.103798.","DOI":"10.1016\/j.critrevonc.2022.103798"},{"key":"2026090815561564114_j_biol-2025-1356_ref_003","doi-asserted-by":"crossref","unstructured":"Duma, MN, ReneBudach, WD, JuergenFeyer, PF, RainerHaase, W, WolfgangHehr, TK, DavidPiroth, MS, et al.. Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO). 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