S3000
Invited Speaker
ESTRO 2026
indications for breast BT have gained evidence based acceptance: 1. Accelerated partial breast irradiation (APBI) as adjuvant radiotherapy option for the primary treatment of early-stage breast cancer: The mature results of multiple prospective phase 2 and 3 clinical trials proved the non-inferiority of APBI compared to WBI. Based on emerging clinical evidence, the original GEC-ESTRO APBI patient selection criteria developed in 2010 have recently been updated, allowing more patients to be treated with APBI in the future, as part of daily clinical practice. 2. Salvage APBI as a part of 2 nd. breast conserving therapy (BCT): Despite adequate BCT, including adjuvant WBI, the rate of local recurrence (LR) is approximately 10%. In such cases, salvage mastectomy (MT) has been the standard treatment, however, 2 nd. BCT may also be a reasonable option for selected patients. The incidence of second LR after repeat conservative surgery has been reported in the range of 7 to 50%, which can be decreased with reirradiation using breast BT. Based on the promising results of single-institution studies, and the multicentric retrospective analysis of the GEC- ESTRO Breast Cancer Working Group, second BCT and reirradiation with BT has become a standard alternative to MT for the management of LR following prior BCT. Implantation technique, image-based target volume definition, dose prescription, and fractionation schedules have also improved in the past decades, contributing to better target volume coverage, dose homogeneity, as well as a reduction in the incidence and severity of late side effects of breast BT. Recently, further acceleration of the delivery of partial breast irradiation has become a viable option. Very accelerated partial breast irradiation (VAPBI) using one- to three- day treatment schedules opens up a new horizon for the application of breast BT. 5316 Gynaecological highlights and innovations Gemma Eminowicz Oncology, University College London Hospital, London, United Kingdom This session provides a succinct overview of recently published articles that are driving innovation in the field of brachytherapy for gynaecological cancer. These are presented in 3 key themes; optimisation of imaging modalities in delivery of image guided adaptive brachytherapy, covering use of computed tomography, transrectal ultrasound and diffusion weighted magnetic resonance imaging; improvements in patient experience and toxicity including data on sexual and psychosocial impact of gynaecological
by predictive algorithms capable of modelling intraprocedural prostate motion.
Finally, combination and escalation strategies continue to evolve. The 2025 American Brachytherapy Society consensus confirms that HDR BT boost combined with external beam radiotherapy (EBRT) provides superior biochemical control compared to dose-escalated EBRT alone. Emerging phase II data are exploring focal HDR boosts combined with stereotactic radiotherapy to maintain oncologic benefit while reducing toxicity. Additionally, radioligand therapies are beginning to intersect with BT, with early trials suggesting synergistic potential. This presentation synthesizes recent advances in imaging, focal therapy, AI, robotics, and dose escalation, providing a clinically relevant overview of the current state and future direction of next- generation prostate brachytherapy. References: Br J Radiol. 2025;98(1167):354–367. doi:10.1093/bjr/tqae254
Radiother Oncol. 2025;211:111091. doi:10.1016/j.radonc.2025.111091 Brachytherapy. 2025;24(5):644–662. doi:10.1016/j.brachy.2025.06.005 Clin Oncol (R Coll Radiol). 2026;52:104085.
doi:10.1016/j.clon.2026.104085 Front Oncol. 2022;12:971344. doi:10.3389/fonc.2022.971344 Radiother Oncol. 2025.
doi:10.1016/j.radonc.2025.045463 Brachytherapy. 2024;23(2):188–198. doi:10.1016/j.brachy.2023.10.005 Front Robot AI. 2024;11:1416662. doi:10.3389/frobt.2024.1416662 Med Phys. 2019;46:4404–4412 Radiat Oncol. 2022;17:214. doi:10.1186/s13014-022- 02173-5 Lancet Oncol. 2020;21(9):1241–1250 J Clin Oncol. 2025 (online ahead of print), Nov 12 2025 Int J Radiat Oncol Biol Phys. 2017;98(2):275–285
5315 Breast brachytherapy breakthroughs: Targeting
with finesse Csaba Polgar
Department of Radiotherapy, National Institute of Oncology, Budapest, Hungary. Department of Radiotherapy, Semmelweis University, Budapest, Hungary For decades, the traditional indication for breast brachytherapy (BT) has been to deliver an additional (boost) dose to the tumour bed after whole breast irradiation (WBI). In the last three decades, new
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