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Purpose: This guideline provides evidence-based recommendations on appropriate indications and techniques for partial breast irradiation (PBI) for patients with early-stage invasive breast cancer and ductal carcinoma in situ., Methods: ASTRO convened a task force to address 4 key questions focused on the appropriate indications and techniques for PBI as an alternative to whole breast irradiation (WBI) to result in similar rates of ipsilateral breast recurrence (IBR) and toxicity outcomes. Also addressed were aspects related to the technical delivery of PBI, including dose-fractionation regimens, target volumes, and treatment parameters for different PBI techniques. The guideline is based on a systematic review provided by the Agency for Healthcare Research and Quality. Recommendations were created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength., Results: PBI delivered using 3-dimensional conformal radiation therapy, intensity modulated radiation therapy, multicatheter brachytherapy, and single-entry brachytherapy results in similar IBR as WBI with long-term follow-up. Some patient characteristics and tumor features were underrepresented in the randomized controlled trials, making it difficult to fully define IBR risks for patients with these features. Appropriate dose-fractionation regimens, target volume delineation, and treatment planning parameters for delivery of PBI are outlined. Intraoperative radiation therapy alone is associated with a higher IBR rate compared with WBI. A daily or every-other-day external beam PBI regimen is preferred over twice-daily regimens due to late toxicity concerns., Conclusions: Based on published data, the ASTRO task force has proposed recommendations to inform best clinical practices on the use of PBI., Competing Interests: Disclosures All task force members’ disclosure statements were reviewed before being invited and were shared with other task force members throughout the guideline's development. Those disclosures are published within this guideline. Where potential conflicts were detected, remedial measures to address them were taken. Bethany Anderson: American Board of Radiology (ABR) (board examiner), Brachytherapy Journal (section editor), Clinical Breast Cancer Journal (associate editor), International Journal of Radiation Oncology, Biology, Physics (breast section associate editor), School of Breast Oncology (honoraria); Douglas Arthur: Advanced Radiation Therapy (consultant); Jose Bazan: ABR (board examiner), ASTRO VA Breast Panel (honoraria), International Journal of Radiation Oncology, Biology, Physics (breast section associate editor), Intraop Medical (institutional research); Jennifer Bellon: American Board of Radiology (ABR) (oral exam chair-ended 8/2023), Leidos Pharmaceutical (honoraria), National Cancer Institute (NCI) (research; BOLD task force on breast cancer co-chair), Oncoclinicas (honoraria), PER (honoraria), Prosigna (research), UpToDate (honoraria), Varian (honoraria); Charlotte Coles: Breast Cancer Now (research), Cancer Research UK (research), Lancet Breast Cancer Commission (chair), National Institutes of Health and Care Research (NIHR) (research; IMPORT LOW trial chief investigator); Naamit Gerber: Accuray (advisory board-ended 10/2023), Invus Group (consultant), John Theurer Cancer Center (consultant), Mount Sinai Icahn School of Medicine (honoraria-ended 8/2022), PreludeDX (research); Leonard Kim: American Associations of Physicists in Medicine (subcommittee/working group chair), ABR (board examiner), Elekta (MR-Linac Consortium, institutional representative), The Greeley Company (consultant-ended 5/2022); Christine Laronga (Society of Surgical Oncology [SSO]representative): SSO Breast Disease Site (chair), UpToDate (section editor); Janice Lyons (Chair): ABR (board examiner), Primum (consultant); Icro Meattini: Accuray, Eli Lily, Ipsen, Novartis, Pfizer, Seagen (all advisory board); Elizabeth Nichols: ABR (board examiner), Applied Radiation Oncology (editorial board), Xcision (research, co-chair); Lori Pierce (American Society of Clinical Oncology [ASCO] representative): ASCO (board chair), Breast Cancer Research Foundation (advisory board and travel), BMS Foundation DCIDCP National Advisory Committee (advisory board and travel), Damon Runyon Cancer Research Foundation (board of directors and travel), Exact Sciences (consultant), Michigan Radiation Oncology Quality Consortium (director), PER Educational Symposium (speakers bureau and travel), UpToDate (editor); Matthew Poppe: Agency for Healthcare Research and Quality (technical expert), Alliance for Breast Clinical Trials in Oncology (vice chair), Alliance for Breast Clinical Trials Local Regional Working Group (chair), Mevion (honoraria and travel-ended 3/2022), NIH (research), NIH/NCI (research-PI), PEEL Therapeutics (stock), UpToDate (editor); Simona Shaitelman (Vice Chair): Alpha Tau Medical (research-ended 2022), Artios Pharma (research-ended 2022), Becton, Dickinson & Co (consultant), Brachytherapy Journal (editorial board), Elekta (MR-Linac Consortium, institutional representative), Emerson Collective Foundation (research), Exact Sciences (research), NIH (research-ended 8/2023), TAE Life Sciences (research); Patti Spears (patient representative): Pfizer (advocate advisory care committee member-ended 12/2022); Shaveta Vinayak (ASCO representative): OncoSec Biotech (research and consultant), Pfizer, Puma Biotech, Seattle Genetics (all research); Timothy Whelan: Exact Sciences (research). Lisa Bradfield and Madeera Kathpal (Guideline Subcommittee representative) reported no disclosures., (Copyright © 2023 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)

Novel systemic therapies for breast cancer are being rapidly implemented into clinical practice. These drugs often have different mechanisms of action and side-effect profiles compared with traditional chemotherapy. Underpinning practice-changing clinical trials focused on the systemic therapies under investigation, thus there are sparse data available on radiotherapy. Integration of these new systemic therapies with radiotherapy is therefore challenging. Given this rapid, transformative change in breast cancer multimodal management, the multidisciplinary community must unite to ensure optimal, safe, and equitable treatment for all patients. The aim of this collaborative group of radiation, clinical, and medical oncologists, basic and translational scientists, and patient advocates was to: scope, synthesise, and summarise the literature on integrating novel drugs with radiotherapy for breast cancer; produce consensus statements on drug-radiotherapy integration, where specific evidence is lacking; and make best-practice recommendations for recording of radiotherapy data and quality assurance for subsequent studies testing novel drugs., Competing Interests: Declaration of interests IMe declares participation in advisory boards supported by Eli Lilly, Novartis, Pfizer, Pierre Fabre, SeaGen, Daiichi Sankyo, and AstraZeneca. CB declares honoraria from Eli Lilly, and participation in advisory boards supported by Eli Lilly, Novartis, Pfizer, and Amgen. ML received honoraria from or participated in advisory boards for Roche, Novartis, Eli Lilly, Pfizer, AstraZeneca, Daiichi Sankyo, Gilead, SeaGen, Merck Sharp and Dohme, Exact Sciences, Takeda, Ipsen, Sandoz, Libbs, and Knight; received a travel grant from Gilead; and received research support for their institution from Gilead. EdA declares honoraria from or participation in advisory boards for Roche, Genentech, Novartis, SeaGen, Zodiac, Libbs, Pierre Fabre, Eli Lilly, and AstraZeneca. JC declares consulting or advisor roles supported by Roche, Celgene, Cellestia, AstraZeneca, SeaGen, Daiichi Sankyo, Erytech, Athenex, Polyphor, Eli Lilly, Merck Sharp and Dohme, GSK, Leuko, Bioasis, Clovis Oncology, Boehringer Ingelheim, Ellipses, Hibercell, BioInvent, Gemoab, Gilead, Menarini, Zymeworks, Reveal Genomics, and Expres2ion Biotechnologies. NH declares honoraria for lectures or consulting from AstraZeneca, Daiichi Sankyo, Gilead, Eli Lilly, Merck Sharp and Dohme, Novartis, Pierre Fabre, Pfizer, Roche, Sanofi, Sandoz, and SeaGen. HSR declares institutional research support from Astellas Pharma, AstraZeneca, Daiichi Sankyo, F Hoffmann-La Roche, Genentech, Gilead Sciences, GSK, Eli Lilly, Merck & Co, Novartis Pharmaceuticals Corporation, OBI Pharma, Pfizer, Pionyr Immunotherapeutics, Sermonix Pharmaceuticals, Taiho Oncology, and Veru. GC reports personal fees for consulting, advisory roles, and speakers’ bureau from Roche, Genentech, Novartis, Pfizer, Eli Lilly, Foundation Medicine, Samsung, and Daiichi Sankyo; honoraria from Ellipses Pharma; and fees for travel and accommodations from Roche, Genentech, and Pfizer. LV declares participation in advisory boards from Daiichi Sankyo and Pfizer. ME declares participation in advisory boards supported by Pfizer and Novartis, and lecture fees supported by AstraZeneca. TS declares participation in advisory boards supported by Bristol Myers Squibb, Merck Sharp and Dohme, Novartis, and Pierre Fabre; and lecture fees supported by Astellas, AstraZeneca, and Bristol Myers Squibb. GM declares consultancy honoraria from Roche, Novartis, AstraZeneca, Pfizer, Jensen, Eli Lilly, and Sanofi. LDM declares consulting fees from Roche, Novartis, Eli Lilly, Merck Sharp and Dohme, Daiichi Sankyo, SeaGen, Gilead, Eisai, Pierre Fabre, AstraZeneca, Stemline Menarini, Exact Sciences, Agendia, GSK, and Pfizer. MM declares consulting fees from Cedilla Therapeutics and PharmEnable, and research support from PharmaMar, Eli Lilly, Pfizer, and Circle Pharma. SP-S declares consulting fees from Pfizer, Novartis, Eli Lilly, AstraZeneca, Gilead, Merck, Sharp and Dohme, and Roche. BP declares consulting fees from Astra Zeneca, SeaGen, Gilead, Eli Lilly, Merck Sharp and Dohme, Daiichi Sankyo, and Pierre Fabre. CS declares consulting fees from AstraZeneca, Daiichi Sankyo, Eisai Europe, Gilead, Novartis, Pharmalex, Pfizer, Phillips Health Works, Pierre Fabre, PintPharma, Puma Biotechnology, Roche Farma, SeaGen, Solti, Synthon Biopharmaceuticals, and Zymeworks. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aims: We report our initial 3-year experience of chemoradiotherapy for cervical cancer with computed tomography-based image-guided high dose rate (HDR) brachytherapy using the tandem-ring applicator., Materials and Methods: Twenty-eight patients were treated between February 2005 and December 2007. All patients received initial external beam radiotherapy (EBRT) followed by HDR brachytherapy (planned dose 21 Gy to point A in three fractions over 8 days). For each insertion, a computed tomography scan was obtained with the brachytherapy applicator in situ. The cervix, uterus and organs at risk (OAR) were contoured on the computed tomography images to create an individualised dosimetry plan. The D(90) (the dose delivered to 90% of the tumour target), V(100) (the percentage of tumour target volume receiving 100% of the prescribed dose) and the minimum dose in the most exposed 2 cm(3) volume (D(2 cc)) of rectum, bladder and bowel were recorded. The equivalent dose in 2 Gy fractions delivered by EBRT and brachytherapy was calculated., Results: The 3-year cancer-specific survival was 81%, with a pelvic control rate of 96%. In 24 patients, a D(90)>or=74 Gy (alpha/beta10) was achieved. The only patient with local recurrence had a D(90) of 63.8 Gy(alpha/beta10). The overall actuarial risk of serious late morbidity was 14%. Seventeen patients had satisfactory OAR doses using the standard loading pattern. Seven patients had modifications to reduce the risk of toxicity, whereas two had modifications to improve the tumour dose. Comparison with a previous cohort of patients treated with chemoradiotherapy and a conventionally planned low dose rate triple source brachytherapy technique showed an improvement in local pelvic control of 20% (P=0.04)., Conclusions: The implementation of a computed tomography-based tandem-ring HDR brachytherapy technique in conjunction with individual dose adaptation has resulted in a significant improvement in local control at Addenbrooke's without increasing the risk of serious toxicity, and with little effect on radiotherapy resources.