S293
Clinical - Breast
ESTRO 2026
Material/Methods: In 2025, all cases of IBRT were discussed in a
involving complex oncoplastic surgery techniques and ultra-hypofractionation. This stresses the need for large, multidisciplinary prospective studies with long- term follow-up, providing more evidence for further personalization of treatment to improve outcomes for future breast cancer patients. References: 1. Collette, S., et al., Predictors of the risk of fibrosis at 10 years after breast conserving therapy for early breast cancer: a study based on the EORTC Trial 22881-10882 'boost versus no boost'. Eur J Cancer, 2008. 44(17): p. 2587-99. 2. Vrieling, C., et al., The influence of patient, tumor and treatment factors on the cosmetic results after breast-conserving therapy in the EORTC 'boost vs. no boost' trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups. Radiother Oncol, 2000. 55(3): p. 219-32. 3. Page, M.J., et al., The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021. 372: p. n71. Keywords: Breast-conserving therapy, fibrosis, risk factors Digital Poster 3109 Ultrahypofractionated Re-Irradiation After Repeat Lumpectomy: feasibility and early toxiciticies Eliana La Rocca 1 , Emiliano Salah El Din Tantawy 1 , Valeria Santoro 1 , Carlo Cavedon 2 , Francesca Pellini 3 , Elena Fiorio 4 , Giuseppe Cardano 5 , Alessia Nottegar 6 , Alessandro Muraglia 1 , Nunzia Luna Valentina Cernusco 1 1 Radiotherapy Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 2 Medical Physics Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 3 Breast Surgery Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 4 Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 5 Radiology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 6 Diagnostic and Public Health, University of Verona, Verona, Italy Purpose/Objective: Local recurrence after breast-conserving surgery (BCS) and adjuvant radiotherapy is traditionally managed with salvage mastectomy. However, emerging evidence supports a second conservative approach following partial breast re-irradiation (re-PBI)1,2,3. Within a multidisciplinary setting, this approach represents a valuable alternative to demolition surgery for suitable candidates. The present study aims to evaluate the feasibility and tolerance of five- consecutive-fraction re-PBI using volumetric modulated arc therapy (VMAT) in patients undergoing repeat breast-conserving surgery (re-BCS) for ipsilateral breast cancer recurrence (IBTR).
multidisciplinary tumor board. Patients with single MRI-confirmed lesions fulfilling ESTRO consensus criteria for partial breast irradiation were considered for re-BCS and re-PBI, after prior evaluation of late skin radiotherapy-related toxicity. The re-PBI consisted of five consecutive daily fractions to a total dose of 30 Gy using VMAT. Toxicities were scored according to CTCAE v5.0, and cosmetic results were evaluated by both patients and physicians using the Harvard cosmetic scale. Results: Eleven patients were diagnosed with breast cancer recurrence. Eight underwent new surgery: three received a mastectomy, while five with single MRI- confirmed lesions underwent re-BCS. The remaining three patients received systemic therapy only, due to the presence of distant metastases. The median interval from the first treatment was 17 years (range 15–22), and the median age at recurrence was 74.5 years (range 63–79). Final pathology revealed two pTis lesions (<2 cm) and three pT1 tumors. All patients who underwent re-BCS subsequently completed re-PBI within one week, with no acute toxicities observed.After a median follow-up of six months, reported toxicities included one case each of mild cicatricial fibrosis (G1), hyperpigmentation (G1), and pain (G1), while three patients remained asymptomatic. No toxicity above grade 1 was observed. One case of liponecrosis was identified by breast ultrasound and correlated with pain. All patients reported excellent cosmetic outcomes, confirmed by physicians (four excellent, one good). Conclusion: To our knowledge, this is the first reported clinical experience using an ultrahypofractionated schedule for re-irradiation in partial breast irradiation, demonstrating the feasibility of this approach. Combining repeat lumpectomy and ultrahypofractionated re-PBI in five fractions is safe, feasible, and highly acceptable to patients. The short treatment schedule enables therapy completion in only five visits, offering substantial logistical and psychological benefits, particularly for elderly or remote patients. Avoiding demolition surgery, this strategy supports breast preservation and enhances patient satisfaction within a multidisciplinary decision process. Longer follow-up is warranted to consolidate these encouraging findings. References: 1) Meattini I, et al. Accelerated partial breast irradiation using intensity modulated radiotherapy versus whole breast irradiation: Health-related quality of life final analysis from the Florence phase 3 trial. Eur J Cancer. 2017;76:17-26. doi:10.1016/j.ejca.2017.01.0232)La Rocca E, et al.
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