S228
Clinical - Breast
ESTRO 2026
Radiotherapy and Immediate Breast Reconstruction: Advancing Together ROSARIO CHING-LÓPEZ 1,2 , MARTA GUTIÉRREZ ELIZONDO 1 , ÁNGELA MATÍAS PÉREZ 1 , AISHA HUSSAIN 1 , JOSÉ EXPÓSITO HERNÁNDEZ 1,2 1 RADIATION ONCOLOGY, HOSPITAL UNIVERSITARIO VIRGEN DE LAS NIEVES, GRANADA, Spain. 2 Instituto de Investigación Biosanitaria, ibs.GRANADA, GRANADA, Spain Purpose/Objective: The combination of postmastectomy radiotherapy (PMRT) and immediate breast reconstruction (IBR) remains a complex challenge in breast cancer management. PMRT plays a key role in reducing local recurrence after mastectomy, while IBR aims to restore aesthetics and enhance quality of life. However, their interaction can impact both cosmetic and functional outcomes and may increase the risk of complications. This study aims to analyze the current integration of PMRT and IBR, highlighting recent advances, challenges, and strategies to optimize results. Material/Methods: We retrospectively reviewed all female patients who underwent IBR between January and December 2023 and subsequently received PMRT with either 40.05 Gy in 15 fractions to the chest wall (CW) with or without irradiation of axillary/supraclavicular lymph nodes (LN), or 26 Gy in 5 fractions to the CW with or without axillary LN. Target volume delineation and bolus use were determined at the physician’s discretion. Toxicity was defined as any grade ≥ 3 adverse event (CTCAE) occurring after PMRT initiation. Clinical outcomes and patient satisfaction were assessed at baseline and at 3 and 6 months after completing PMRT. Cox proportional hazard models were used to evaluate the effect of fractionation schedule on the risk of reoperation for reconstruction during follow-up. A Student’s t-test was used to compare aesthetic outcomes with or without contouring according to the ESTRO-ACROP consensus. Results: Median follow-up was 9 months (range 2–15). Six patients received the Fast-Forward schedule and 22 underwent hypofractionated PMRT, one of whom was treated with bolus. LN levels I–II were included in 11 patients, levels III–IV in 13, and the internal mammary chain in 3. No grade ≥ 3 toxicities were reported. Final aesthetic outcomes, as rated by physicians, were excellent in 7 patients, good in 19, fair in 1, and poor in 1. Patient satisfaction was high in 27 cases and moderate in 1. Nine patients required reoperation due to post-PMRT complications. No clinically significant differences were observed between fractionation schemes or between target contouring with versus without prosthesis sparing. All patients remained
dermatitis (ARD) in postmastectomy radiotherapy (RT). Material/Methods: Each irradiated chest wall was divided into medial and lateral halves, randomized to one dressing each. The primary endpoint was the incidence of grade 2 or 3 ARD. Secondary endpoints included grade 3 ARD, moist desquamation, time to moist desquamation, Radiation-Induced Skin Reaction Assessment Scale (RISRAS) scores, adverse events, and treatment preferences. Discordant-pair methods, conditional logistic regression, and fixed-effects models were used. Results: A total of 120 patients (median age, 60 years; interquartile range, 51–69) were included (Australia, n = 40; New Zealand, n = 80); 64.2% received moderate or extreme hypofractionated RT. Discordant-pair analysis showed grade 2 or 3 ARD occurred more frequently on StrataXRT sides (78.9%) than Mepitel Film sides (21.1%, paired risk difference 57.9%, 95% CI 31.9–83.8; p < 0.001). Grade 3 ARD and moist desquamation were infrequent and not significantly different. HCP-assessed RISRAS scores showed significantly lower erythema (p < 0.001) and moist desquamation (p = 0.033) with Mepitel Film over time, while patient-assessed RISRAS scores showed no between-group differences. Patient preferences were Mepitel Film significantly reduced the incidence of grade 2 or 3 ARD and HCP-assessed skin reactions compared with StrataXRT, with a similar patient- reported symptom burden. Choices of prophylactic dressings should consider patient preference, cost, ease of application, skin sensitivity, and resources. References: [1] Lee SF, Yip PL, Spencer S, Ho H, Subramanian B, Ding W, et al. StrataXRT and Mepitel Film for Preventing Postmastectomy Acute Radiation Dermatitis in Breast Cancer: An Intrapatient Noninferiority Randomized Clinical Trial. Int J Radiat Oncol Biol Phys 2025;121:1145–55. evenly split. Conclusion: https://doi.org/10.1016/j.ijrobp.2024.11.076.[2] Herst P, van Schalkwyk M, Baker N, Thyne R, Dunne K, Moore K, et al. Mepitel Film Versus StrataXRT in Managing Radiation Dermatitis in an Intra-Patient Controlled Clinical Trial of 80 Postmastectomy Patients. Journal of Medical Imaging and Radiation Oncology 2025;n/a. https://doi.org/10.1111/1754-9485.13850. Keywords: mastectomy; radiodermatitis; treatment outcome
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