S343
Clinical - Breast
ESTRO 2026
0.05.An exploratory analysis of routine echocardiography assessed standard left ventricular ejection fraction (LVEF), where available.The study was approved by the local Ethics Committee and conducted in accordance with the Declaration of
life or cosmetic outcomes. The type of reconstruction did not influence patient-reported outcomes. Continued efforts should focus on optimizing survivorship and psychosocial well-being among breast cancer patients receiving multimodality treatment. References: Yun JH, Diaz R, Orman AG (2018) Breast Reconstruction and Radiation Therapy. Cancer Control 25(1):1073274818795489Broyles JM, Balk EM, Adam GP et al (2022) Implant-based versus Autologous Reconstruction after Mastectomy for Breast Cancer: A Systematic Review and Meta-analysis. Plast Reconstr Surg Glob Open 10(3):e4180 Keywords: reconstruction, cosmesis , radiotherapy Real-world feasibility and cardiac sparing with ABC-DIBH across different fractionation regimens in left-sided breast radiotherapy: BRAVE-HEART trial Elisabetta Bonzano 1 , Luigi Squillace 1 , Andrea Lancia 1 , Jessica Saddi 1 , Salvatore La Mattina 1 , David Alberto Santos 1 , Sara Colombo 1 , Paolo Pedrazzoli 2 1 Radiation Oncology, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy. 2 Oncology, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy Digital Poster Highlight 4922 Purpose/Objective: Active Breath Control (ABC) with Deep Inspiration Breath Hold (DIBH) effectively reduces cardiac exposure in left-sided breast cancer (LBC). The ambispective single-centre BRAVE-HEART trial explored real-world feasibility and clinical predictors of cardiac dose reduction. Understanding which patient- related factors drive the magnitude of benefit may refine patient selection and personalised coaching in Four hundred consecutive prospective LBC patients treated with three different schedules 26 Gy/5 fx, 40 Gy/15 fx, or 50 Gy/25 fx ± SIB were analysed.All DIBH treatments were delivered using the Active Breathing Coordinator (ABC) system to ensure reproducible breath-hold control and gating.Feasibility was defined as breath-hold (BH) ≥ 20 s and inspiratory threshold ≥ 1.4 L, consistent with published ABC-DIBH benchmarks.Cardiac doses (Heart Dmean, LAD Dmean, LAD Dmax) were compared using Mann– Whitney U tests; effect sizes were expressed as Cohen’s d.Predictors of Heart Dmean reduction were examined via multivariate linear regression including age, fractionation, inspiratory threshold, and BH routine radiotherapy. Material/Methods: duration.Normality was verified (Shapiro–Wilk); correlations used Spearman’s ρ ; significance p <
Helsinki. Results:
Median age 64 years (29.9% > 70).Most patients achieved the predefined feasibility targets: 99.4% BH ≥ 20 s and two-thirds threshold ≥ 1.4 L.Elderly women maintained comparable BH duration (25 s; p=0.056) but slightly lower inspiratory volumes (1.4 vs 1.5 L; p<0.001).Higher inspiratory threshold correlated with lower Heart Dmean ( ρ = –0.22; p=0.004) and remained the only independent predictor of cardiac dose reduction ( β = –0.19 Gy/L; p=0.008).Significant dose reductions with ABC-DIBH were confirmed for all regimens (p<0.001 for Heart, LAD Dmean, and LAD Dmax).No workflow disruptions occurred.Exploratory echocardiography showed stable LVEF before and after RT, consistent with preserved short-term cardiac function. Conclusion: Inspiratory capacity, not age or fractionation, independently predicts the magnitude of cardiac and LAD dose reduction with ABC-DIBH.Feasibility was excellent across all regimens, including elderly patients.Significant cardiac and LAD dose sparing was consistently achieved across all fractionation schedules, confirming the robustness of ABC-DIBH in modern breast radiotherapy.Exploratory echocardiography supports preserved short-term LVEF.Integrating simple respiratory-performance metrics into coaching may optimise patient-specific cardiac protection in daily practice References: Nissen HD, Appelt AL. Deep inspiration breath-hold in breast cancer radiotherapy: a systematic review. Radiother Oncol. 2018;126:286–292.Wolf J et al. Deep inspiration breath-hold radiotherapy in left-sided breast cancer: a retrospective dosimetric analysis. Strahlenther Onkol. 2023;199:379–388.Rudat V et al. Impact of deep inspiration breath hold, surface-guided radiotherapy, and daily CBCT on organs at risk in breast cancer radiotherapy. Sci Rep. 2024;14:27814. Keywords: Breast Cancer, DIBH, Hypofractionation
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