S3018
Invited Speaker
ESTRO 2026
5369 Should we continue rectal preparation for prostate cancer radiotherapy? Sophie E Alexander Academic Radiography, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom. Division of Radiotherapy & Imaging, The Institute of Cancer Research, Sutton, United Kingdom Contemporary radiotherapy (RT) for prostate cancer utilises daily online volumetric image guided RT (IGRT), aligning to the prostate gland to correct for inter- fraction motion[1,2]. Despite having sophisticated correction strategies in place to treat prostate cancer, many institutions still impose strict rectal preparation regimes and rectal diameter constraints. These practices, which were essential to improve RT accuracy in the era of two-dimensional bone-based IGRT, were instigated by historical reports that large rectal volumes at pre-treatment stage caused excessive prostate motion, target underdosing and higher biochemical failure rates[3–5]. IGRT innovations have alleviated these fears regarding prostate cancer outcome[6,7] yet burdensome preparation regimes remain. Preparation protocols implemented are also typically the same for all patients, despite varying efficacy across the population. This presentation will start by giving an overview of the literature instigating the use of rectal preparation for prostate cancer RT. Common rectal preparation regimes will be introduced and patient experience and effectiveness of these examined. Having stopped rectal preparation for patients receiving radiotherapy for localised prostate cancer at our institution in October 2023, the impact of this will be shown with respect to inter- and intra-fraction prostate motion, rectal volume and correlation between the two. The results of a service evaluation examining individuals’ experience preparing for prostate cancer radiotherapy, with and without rectal preparation, will also be presented. Finally, the presentation will ask the question; do the results support stopping rectal preparation for all patients receiving prostate cancer radiotherapy? This will be discussed with reference to the treatment target, patient specific medical history and RT treatment platform. References: 1. Radiotherapy Board (2021) On target 2: updated guidance for IGRT . 2. Ghadjar, P. et al. (2019) Radiother Oncol , 141, pp.5– 13. 3. De Crevoisier, R. et al. (2005) Int J Radiat Oncol Biol Phys , 62, pp.965–973. 4. Engels, B. et al. (2009) Int J Radiat Oncol Biol Phys , 74, pp.388–391. 5. Heemsbergen, W.D. et al. (2007) Int J Radiat Oncol
Biol Phys , 67, pp.1418–1424. 6. Kupelian, P.A. et al. (2008) Semin Radiat Oncol , 18, pp.58–66. 7. Silverman, R. et al. (2015) Oncology , 90, pp.51–56.
5370 Joint ESMO & ESTRO guidelines on combined modality treatment: lessons learned and translation into clinics Icro Meattini Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy. Radiation Oncology Department, Breast Unit, Florence University Hospital, Florence, Italy The integration of systemic therapies and radiation therapy (RT) represents a cornerstone of modern oncology, yet optimal strategies for sequencing, combination, and patient selection remain incompletely defined. Breast cancer has emerged as a leading model for combined modality treatment, supported by extensive clinical evidence and multidisciplinary collaboration. This presentation summarises key lessons derived from joint European initiatives in breast cancer, and discusses how these principles can be translated into broader clinical practice. It is based on a narrative synthesis of recent consensus recommendations, pivotal clinical trials, and systematic reviews on RT-drug combinations, with particular emphasis on clinically relevant domains such as treatment sequencing, safety of concurrent or overlapping strategies, and integration of novel systemic agents including targeted therapies, antibody-drug conjugates, immunotherapy, and endocrine therapy. Breast cancer provides robust evidence supporting the safe and effective integration of RT with multiple classes of systemic therapies, although the level of evidence varies across agents and clinical scenarios. Key lessons include the importance of multidisciplinary coordination to optimise timing and avoid compromising systemic therapy delivery, the generally favourable safety profile of many RT-drug combinations with modern techniques, and the need for caution and individualisation when combining RT with newer agents where prospective data remain limited. In addition, the experience highlights the critical role of harmonised definitions, endpoints, and toxicity reporting in advancing the field, as well as the value of consensus-driven frameworks to bridge evidence gaps and provide pragmatic guidance for clinicians. Overall, the ESMO-ESTRO collaboration in breast cancer illustrates how structured multidisciplinary efforts can accelerate the safe implementation of combined modality treatments. Breast cancer serves
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