S251
Clinical - Breast
ESTRO 2026
Digital Poster 1656 Chronic breast hyperpigmentation after radiotherapy following conservative surgery: A hidden psychosexual consequence of cure Nouhaila Benider, Imane Hassnaoui, Sara Taimi, Karima Nouni, Amine Lachgar, Hanane El Kacemi, Tayeb Kebdani, Khalid El Hassouni Department of radiation oncology, National Institute of Oncology, Rabat, Morocco Purpose/Objective: Adjuvant radiotherapy (RT) after breast-conserving surgery ensures excellent local control and survival in early breast cancer. However, chronic skin sequelae may compromise long-term quality of life. Persistent hyperpigmentation, a late expression of radiodermatitis, can act as a visible reminder of cancer, particularly distressing for women in a culturally sensitive environments.This study assessed the incidence and psychosexual impact of chronic breast hyperpigmentation after RT. Material/Methods: A retrospective review of 452 women treated with conservative surgery and hypofractionated radiotherapy (42 Gy/15 fractions ± boost 11.2 Gy/4 fractions) between 2020 and 2022 showed acute radiodermatitis in 71.5% of cases, with 19% being grade 2–3. Chronic hyperpigmentation occurred exclusively among these higher-grade cases, affecting 27 patients (6% of all irradiated). All affected women had received a tumor-bed boost. Psychosocial interviews assessed body image and sexual confidence impacts. Results: Chronic breast hyperpigmentation caused a notable psychosexual burden: 59% reported loss of sexual confidence, discomfort during intimacy, or avoidance of physical contact with their partner; 63% described aesthetic discomfort and a feeling of shame related to the discolored breast.; 48% experienced reduced self- esteem and loss of femininity.; 41% expressed emotional distress linked to asymmetry or visible discoloration. Only 22% had received psycho- oncological counseling. Conclusion: Chronic breast hyperpigmentation represents a psychosocial scar affecting body image and intimacy. Its link with boost irradiation highlights a modifiable factor. Integrating cosmetic and psychological follow- up may reduce this hidden long-term burden. Keywords: Late effect, Body image, sexual confidence
stage invasive breast cancer who underwent lumpectomy followed by adjuvant whole-breast irradiation of 28 Gy in 5 fractions, delivered twice per week. Radiation was delivered using a 3D conformal radiotherapy (3D-CRT) technique, with the prone position used as the standard setup. Acute and late radiation toxicities were graded using CTCAE version 5.0, and cosmetic outcomes were evaluated by physicians using the Harvard scale. Results: From February 2020 to March 2025, a total of 94 patients were included. The median age was 72 years. T1 disease was the most common (69.1%), and 18.1% had pure DCIS. 92.6% of patients were estrogen receptor positiv and 74.5% were progesterone receptor positive. HER2 was negative in 96.1% of invasive cases. Oncotype DX scores were available in 45.5% of invasive cases, with a median score of 16. Most patients (79.8%) received endocrine therapy. All patients were treated with 3D-CRT, and 96.8% were treated in the prone position.No grade 3 or higher acute or late toxicities were observed. The most common acute grade 1–2 toxicities included fatigue (71%), dermatitis (53.3%), hyperpigmentation (29.9%), breast pain (29.3%), breast edema (24.4%), and pruritus (17.7%). At 1 year, the most frequent late toxicities were skin induration (75.8%), fatigue (58.8%), breast atrophy (56.9%), and hyperpigmentation (54.1%). Cosmetic assessment was available in 80 patients at 1 year, with 98.8% showing excellent-to- good results and 1.2% fair. Conclusion: An ultrahypofractionated regimen of 28 Gy in 5 fractions delivered twice weekly in the prone position using 3D-CRT is safe, feasible, and provides excellent cosmetic outcomes. Longer follow-up and larger patient cohorts are needed to assess long-term oncologic efficacy. References: 1. Brunt, A. M. et al. Ten-Year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole- Breast Radiotherapy for Early Breast Cancer. J Clin Oncol38, 3261-3272, doi:10.1200/JCO.19.02750 (2020).2. Murray Brunt, A. et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST- Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet395, 1613-1626, doi:10.1016/S0140-6736(20)30932-6 (2020).3. Vesprini, D. et al. Effect of Supine vs Prone Breast Radiotherapy on Acute Toxic Effects of the Skin Among Women With Large Breast Size: A Randomized Clinical Trial. JAMA Oncology8, 994-1000,
doi:10.1001/jamaoncol.2022.1479 (2022). Keywords: Ultrahypofractionation, radiation,
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