S352
Clinical - Breast
ESTRO 2026
questionnaire addressing evaluation, intervention, dosage, and safety; (3) international expert consultation (n=100 invitations, 21 responses, 10 complete) using a 0–10 Likert scale; and (4) normative synthesis based on predefined thresholds ( ≥ 7.6 = strong recommendation). Descriptive statistics, coefficient of variation (CV), and sensitivity analysis ( ≥ 7.0) assessed consensus robustness. Results: Consensus was high for essential evaluation domains: arm perimetry (mean 9.1 ± 0.7), shoulder goniometry (8.7 ± 0.9), pain assessment (EVA/NRS, 8.5 ± 1.0), DASH/QuickDASH functional index (8.8 ± 0.8), and sensory testing (8.0 ± 1.1). Core therapeutic modalities included active mobility (9.6 ± 0.5), supervised resistance training (8.3 ± 0.9), and aerobic exercise (8.6 ± 0.8). Myofascial release was classified as adjunctive (8.0 ± 1.0), while isolated passive stretching was rated low (5.0 ± 1.4). The final protocol recommends a 9–12- week program, five 30–60-minute sessions per week, progressive resistance (60–80% 1RM), aerobic conditioning (50–70% HRmax), and structured evaluation at baseline, mid-RT, and 4–6 weeks post-RT. A decision algorithm establishes objective criteria for progression, pause, and safety surveillance (skin, pain, edema). Conclusion: The proposed consensus-based physiotherapeutic protocol provides a reproducible, evidence-driven framework for functional rehabilitation during adjuvant breast radiotherapy. By defining objective evaluation measures, explicit exercise dosing, and quality assurance mechanisms (checklists, adherence metrics, audit cycles), it bridges technological progress in RT with patient-centred rehabilitation. Prospective multicentre validation is warranted to confirm clinical efficacy and cost-effectiveness in diverse healthcare settings. References: McLaughlin SA, Staley AC, Vicini F, Thiruchelvam PTR, Hutchison NA. Lymphedema incidence after sentinel lymph node biopsy for breast cancer: a contemporary systematic review. Breast J. 2021;27(5):376–84.DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2018;19(1):104–14.McNeely ML, Peddle C, Yurick J, Culos-Reed SN, Langelier D, Brasher P, et al. Effect of exercise on upper extremity pain and dysfunction in breast cancer survivors: a randomized controlled trial. J Clin Oncol. 2016;34(15):1713–20. Keywords: functional outcomes, rehabilitation, consensus
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