S246
Clinical - Breast
ESTRO 2026
Digital Poster 1583
Acute skin response after ultra-hypofractionated FAST-Forward radiotherapy for breast cancer: a single-center analysis Mara Caroprese 1 , Angela Barillaro 2,1 , Christina A Goodyear 1 , Emanuele Chioccola 1 , Cobaj Musa 2 , Caterina Oliviero 3 , Manuel Conson 1,2 , Laura Cella 4 , Roberto Pacelli 1,2 1 Department of Cardiovascular Sciences, Diagnostic Imaging and Time-Dependent Network of Cardiovascular Emergencies, University Hospital "Federico II", Napoli, Italy. 2 Department of Advanced Biomedical Sciences, University Hospital "Federico II", Napoli, Italy. 3 UOSD Fisica Sanitaria e Radioprotezione, University Hospital "Federico II", Napoli, Italy. 4 Institute of Biostructures and Bioimaging, University Hospital "Federico II", Napoli, Italy Purpose/Objective: Extreme hypofractionated schedules are increasingly adopted in breast cancer radiotherapy (RT). The aim of this study was to describe acute skin reactions (ASR) in breast cancer patients treated according to the FAST- Forward protocol [1], and to explore potential predictive factors including patient-, treatment-, and skin phototype–related characteristics. Material/Methods: We retrospectively analyzed 234 consecutive patients treated with adjuvant RT using the FAST-Forward protocol (26 Gy in 5 fractions over 1 week) at our institution between October 2023 and September 2025. A simultaneous integrated boost (SIB) to 29 Gy targeting the tumor bed was delivered in 96 patients
Conclusion: Higher doses to the pectoralis minor, deltoid, and trapezius were associated with pain in extremity following breast cancer radiotherapy. This study also contributed to the development of an AI model for automated muscle segmentation in radiotherapy treatment position, which will be publicly available. These insights may support future research into the optimization of radiotherapy planning in order to reduce arm morbidity and improve quality of life in breast cancer survivors. References: Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, et al. Effect of radiotherapy after breast- conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10.801 women in 17 trials. Lancet. 2011 Nov 12; 378(9804): 1707-16. Leonardis JM, Lulic- Kuryllo T, Lipps DB. The impact of local therapies for breast cancer on shoulder muscle health and function. Crit Rev Oncol Hematol. 2022 Sep; 177: 1-9. Lipps DB, Sachdev S, Strauss JB. Quantifying radiation dose delivered to individual shoulder muscles during breast radiotherapy. Radiother and Oncol. 2017 Mar; 122: 431-436. Keywords: Automated segmentation, Muscle dose, Radiotherapy
(41%). Clinical variables (age, BMI, diabetes, hypertension, smoking status, phototype,
autoimmune disease) and treatment parameters (CTV volume, treatment duration, RT technique, breath- hold use, and boost) were collected. ASR occurring during or within 30 days after RT were scored according to RTOG criteria and dichotomized as grade 0–1 versus grade ≥ 2. Associations between ASR grade and clinical/treatment variables were assessed using non-parametric tests (Mann–Whitney) and logistic regression. A p-value <0.05 was considered statistically significant. Results: Patient and treatment characteristics are summarized in Table 1. Forty-nine patients (20.9%) and 133 (56.8%) experienced grade 2 and grade 1 ASR, respectively; no events above grade 2 were observed. The overall rate of grade 2 ASR was comparable with previously published data for the same schedule.
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