S320
Clinical - Breast
ESTRO 2026
adherence to guideline-based practice. Material/Methods: We retrospectively reviewed all breast cancer patients referred for radiotherapy (RT) from 2018–2024, stratifying fractionation as conventional whole-breast irradiation (CF-WBI; ~50 Gy/25 fractions), hypofractionation (40.05 Gy/15 or 42.5 Gy/16), and ultra-hypofractionation ( ≈ 26 Gy/5). Among those receiving breast-conserving therapy (BCT), we assessed annual HF-WBI adoption, age distribution (<50 vs ≥ 50 years), and boost use. Results: Across yearly datasets, HF-WBI increased steadily and substantially. In 2018, HF-WBI accounted for 17/138 CF/HF cases (12.3%). Uptake rose through 2019 (21.0%), 2020 (27.1%), 2021 (43.4%), 2022 (38.6%), 2023 (54.6%), and reached 82.4% in 2024 (103 HF vs 22 CF). Ultra-hypofractionation ( ≈ 26 Gy/5) appeared from 2022 onward at low but increasing levels (e.g., 6 cases in 2024). Boost delivery was used across schedules; HF-WBI frequently included a boost (e.g., 59 cases in 2023; 70 in 2024), indicating protocol flexibility without abandoning shorter courses. Importantly, HF-WBI was used in both younger and older patients (e.g., 2024: <50 y = 32; ≥ 50 y = 70 within HF cases), reflecting rising clinician confidence across age groups as guideline- concordant practice matured. Conclusion: Our multi-year review demonstrates a decisive transition from conventional to hypofractionated breast RT, with HF-WBI becoming the predominant regimen by 2024. Real-world implementation was feasible with sustained boost utilisation and broad age inclusivity, aligning with international guidelines while improving patient convenience and departmental efficiency. Wider adoption of HF-WBI—and selective use of ultra-hypofractionation—can expand equitable access and support service sustainability in resource- constrained health systems.Recommendations1. Adopt “HF-by-default” for eligible BCT patients, requiring a documented exception for CF-WBI.2. Scale a FAST-Forward pathway ( ≈ 26 Gy/5) where clinically appropriate with clear selection criteria.3. Standardise boost indications in HF schedules (e.g., 10–16 Gy in 4–8 fractions).4. Embed age-agnostic eligibility in MDM checklists to avoid age-based bias against HF.5. Bundle HF-WBI with DIBH planning QA for left-sided cases to maintain cardiac/lung constraints.6. Implement a KPI dashboard tracking HF share, median treatment days, boost rate, and re-planning rate.7. Update patient- facing education to explain HF schedules and boost delivery, improving adherence. Keywords: Hypofractionated Radiotherapy, BCT
(3006 cGy vs. 2113 cGy; p = 0.043), identifying a high- risk subgroup. Conclusion: Lung volume is the most robust anatomical predictor of coronary artery dose, followed by PTV volume and APD variation. These parameters, easily measurable on the planning CT, can be used for pre-treatment cardiac risk stratification. The identification of patients with anatomical risk factors, such as low lung volume and large PTV, allows for the intensified and personalized application of cardiac-sparing strategies, including mandatory DIBH and IMRT, to minimize long- term cardiotoxicity. Prospective validation of these biomarkers is essential for their definitive clinical implementation. References: Rochet N, Drake JI, Harrington K, et al. Deep inspiration breath-hold technique in left-sided breast cancer radiation therapy: evaluating cardiac contact distance as a predictor of cardiac exposure for patient selection. Pract Radiat Oncol. 2015;5(3):e127- e134. Hayden AJ, Rains M, Tiver K. Deep inspiration breath hold technique reduces heart dose from radiotherapy for left-sided breast cancer. J Med Imaging Radiat Oncol. 2012;56(4):464-472. Nissen HD, Appelt AL. Improved heart, lung and target dose with deep inspiration breath hold in a large clinical series of breast cancer patients. Radiother Oncol. 2013;106(1):28-32. Keywords: breast radiation, cardiac dose, predictive factors Digital Poster 4207 Hypofractionated Radiation Therapy for Breast Cancer: A Unit Review in Alignment with International Guidelines Carol A Benn 1,2 , Mia Hugo 3 , Dominic van Loggerenberg 2 , Karen Singh 4 1 Department of Immunology, University of Pretoria, Johannesburg, South Africa. 2 Netcare Breast Care Centre of Excellence, Milpark Hospital, Johannesburg, South Africa. 3 Wits Donald Gordon Medical Centre, University of the Witwatersrand., Johannesburg, South Africa. 4 Radiation, Sacred Heart Oncology, Johanensburg, South Africa Purpose/Objective: Randomised trials and international guidelines endorse hypofractionated whole-breast irradiation (HF-WBI) as the standard of care for early breast cancer, offering equivalent tumour control with shorter treatment times and reduced system burden. In South Africa, where access and throughput are critical, real-world uptake is particularly relevant. This review evaluates our centre’s adoption of HF-WBI and
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