S248
Clinical - Breast
ESTRO 2026
Digital Poster 1616 Breast Re-irradiation After Second Ipsilateral Lumpectomy (BRASIL): A Phase II Trial Youssef Zeidan 1 , Ross Taylor 1 , Samuel Richter 1 , Joseph Panoff 2 , Maria Amelia Rodriguez 2 , Marcio Fagundes 2 , Ana Botero 2 , Jean-Piere Obeid 2 1 Baptist Health South Florida, Lynn Cancer Institute, Boca Raton, USA. 2 Baptist Health South Florida, Miami Cancer Institute, Miami, USA Purpose/Objective: Women breast cancer incidence has been gradually increasing since the mid 2000s. It is estimated that 4- 10% of breast cancer patients will experience a second breast cancer event during their lifetime. Until today standard of care for such patients after having prior lumpectomy and radiation would be total mastectomy. With advances in surgical, diagnostic, and therapeutic techniques, recent studies show feasibility of giving such patients a second chance at breast conservation. The current protocol proposes a prospective clinical trial aimed at investigating efficacy and safety of partial breast reirradiation. Material/Methods: This multicenter single arm Phase II clinical trial evaluates the efficacy and safety of partial breast reirradiation after a second breast conserving surgery. Eligible patients will receive 15 daily sessions of partial breast re-irradiation, to a total dose of 40 Gy. Primary end point is grade 3 + treatment related adverse events within 1 year from completion of treatment. Secondary end points include local recurrence free survival, overall survival, distant metastasis free survival and mastectomy free survival at 5 years. Results: The BRASIL Phase II trial opened in September 2025 across multiple sites in south Florida. The study has been registered on ClinicalTrial.gov (NCT06867484). The primary study objective is to evaluate the safety of re-irradiation with external beam partial breast irradiation (PBI).The target sample size is 114 patients to be enrolled over a period of 2 years. Conclusion: The current study provides a novel approach for managing breast cancer survivors who experience a second breast event during their lifetime. By leveraging novel advances in radiation therapy planning and delivery, the current study aims to provide select breast cancer patients a second chance for breast conversation. Keywords: Re-irradiation, partial breast radiation
Digital Poster 1613 Automated DIBH breast radiotherapy using TomoDirect and VitalHold on a ring - based LINAC: feasibility, dosimetry and early tolerance Sarra MIDANI 1 , Paul RETIF 2,3 , Sébastien MAKSIMOVIC 2 , Clémence BONDUE 1 , Mohamed YACOUBI 1 , Gianandrea PIETTA 1 , Anwar AL SALAH 2 , Estelle PFLETSCHINGER 2 , Motchy SALEH 2,3 , Abdourahamane DJIBO SIDIKOU 2 , Romain LETELLIER 2 , Fabian TAESCH 2 , Emilie VERRECCHIA-RAMOS 2 , Xavier MICHEL 1 1 Radiation Therapy Department, CHR Metz-Thionville, Metz, France. 2 Medical Physics Unit, CHR Metz- Thionville, Metz, France. 3 CRAN, Université de Lorraine, Nancy, France Purpose/Objective: To evaluate the feasibility, dosimetric quality, workflow efficiency, and early tolerance of automated deep- inspiration breath-hold (DIBH) breast radiotherapy using the VitalHold system on the Radixact platform. Material/Methods: Twenty patients requiring locoregional irradiation were treated between February and September 2025 with TomoDirect in DIBH. Calculated dose/volume parameters for targets and organs at risk (OARs), treatment workflow metrics, and acute toxicities were recorded. Helical tomotherapy plans were reoptimized for comparison. Results: All patients completed DIBH treatment. PTV coverage was consistently achieved (mean V95% 97.2% for low- risk and 99.2% for boost volumes) and OAR constraints were respected. ClearRT image acquisition required 20–32 s. Mean expected beam-on time was 237 s, while delivered beam-on time was 447 s (ratio 2.0); overall fraction duration averaged approximately 10 minutes. A total of 3511 gated beam segments were recorded (mean 20 s each), confirming reproducibility and patient compliance. Compared with helical delivery, TomoDirect reduced contralateral lung and breast exposure, while helical provided slightly lower LAD doses; beam-on times were significantly longer with helical (+49%). Acute toxicities were limited to grade 1 (60%) or 2 (10%) dermatitis and grade 1 esophagitis (15%), with no grade ≥ 3 events at median 2 months. Conclusion: Automated DIBH with VitalHold on a ring-based accelerator is feasible, efficient, and safe for complex breast radiotherapy. This approach achieves robust target coverage, reliable OAR sparing, and favorable early tolerance, representing the first clinical demonstration of fully automated gating on a ring- based platform. Keywords: automated DIBH, ring gantry, complex breasts
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