S257
Clinical - Breast
ESTRO 2026
measurable robust framework for quality assurance, supporting the harmonization of clinical practice and promoting the safe, effective, and widespread adoption of this standard of care. A subsequent implementation study will assess real-world applicability and inform future quality improvement initiatives. Keywords: Hypofractionation, Quality indicators, Radiotherapy Digital Poster 1744 Early Clinical, Toxicity, and Dosimetric outcomes of ultra-hypofractionated radiation in breast carcinoma with or without regional nodal irradiation Swarnaditya Roy 1 , Gousalya Jayakumar 1 , Ebenezer Staines 1 , Shuvadeep Ganguly 2 , Kalaranjani Mohanamuralitharan 1 , Gunaseelan K 1 , Jagadesan P 1 1 Radiation Oncology, JIPMER, Puducherry, India. 2 Medical Oncology, JIPMER, Puducherry, India Purpose/Objective: We aimed to implement five-fraction 1-week ultra- hypofractionated radiotherapy (RT) for early-stage breast carcinoma, including patients requiring regional nodal irradiation (RNI) in our institute. Here we present our initial findings. Material/Methods: Patients of non-metastatic breast carcinoma who were pathologically (pT1-3 and N0-1) following surgery and required adjuvant radiotherapy to the breast or chest wall with or without RNI were retrospectively reviewed. All patients were contoured using ESTRO guidelines, and radiotherapy was planned with either 3D-conformal radiotherapy (3D-CRT) or IMRT for 26 Gy in five fractions over 1 week. Coverage of PTV was evaluated at V90% ≥ 95% and V105% ≤ 10cc. (for 3D- CRT) or ≤ 5-7% (for IMRT). Organs-at-risk constraints included V8Gy ≤ 17% (without RNI) and ≤ 25% (with RNI) for the ipsilateral lung. For left-sided tumours, heart constraints included V7Gy ≤ 5%, V1.5Gy ≤ 30% and Dmean ≤ 2Gy. Patients with either T3 or N1 disease were planned for RNI to the level III and IV. Patients requiring internal mammary nodal radiation were omitted from ultra-hypofractionation. Sequential boost with 12.5 Gy in 5 fractions over 1 week was delivered to all patients undergoing breast conservation and ≤ 50 years or 50-60 years with either grade 3 or lympho-vascular space invasion. Acute toxicities were graded according to CTCAE v5.0. Patients having at least 3 months of follow-up post radiation were taken for survival analysis. Results: From March 2024 to July 2025, forty-six patients were treated with 26 Gy in 5 fractions, and subsequently,
EUSOMA). An international steering committee was convened to critically review, consolidate, and standardize the candidate QIs extracted from the literature, using relevance, measurability, and projected impact as key selection criteria. Validation was performed through a modified Delphi process using the Welphi online platform. The expert panel included 42 participants from 19 countries: 32 radiation oncologists, 4 radiation therapists, 4 patient advocates, and 2 medical physicists. Each QI was rated on a 5-point Likert scale for relevance, associated threshold levels (minimum standard and maximum target value), and feasibility of data collection. Consensus was defined as ≥ 75% agreement. Results: The targeted literature and guideline review identified 183 references, from which 31 candidate QIs were extracted. The steering committee refined these into 9 final QIs (3 clinical, 6 dosimetric). Consensus was achieved for eight of the nine proposed QIs in the first Delphi round, with agreement levels ranging from 77% to 87%. All six dosimetric QIs were validated. One clinical QI concerning the use of a simultaneous integrated boost in ultra-hypofractionation outside of a research setting, did not reach consensus and was reformulated for a second round. Median minimum standard thresholds across validated QIs were 85%, with maximum target value levels between 95% and 100%. Feasibility of data collection as rated high (80% - 96%). Results for each QI are presented in Table 1.Table1: Consensus levels, threshold values and feasibility ratings for the 9 Quality Indicators evaluated in Delphi Round 1.
Conclusion: This Delphi-based international consensus has established a set of eight evidence-based QIs for hypofractionated Breast Radiation Therapy. The second Delphi round is ongoing and the results will be available before ESTRO. These indicators provide a
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