Patterns of practice for breast cancer post-operative radiation therapy in Italy according to the ESTRO-ACROP consensus and AIRO position paper: a national survey on the behalf of the Italian association of radiotherapy and clinical oncology (AIRO)

Purpose: The Breast Cancer Study Group of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) conducted a survey aiming to provide an overview of the policies on radiation therapy (RT) dose and fractionation for whole breast irradiation (WBI), partial breast irradiation (PBI), chest wall (CW) irradiation and regional nodal irradiation (RNI). Materials and methods: In February 2023, 183 Italian RT centres were invited to answer a survey: after a first section investigating general aspects, the questionnaire focused on radiation oncologists’ (ROs) attitude regarding breast cancer post-operative RT dose and fractionation. Surveyed ROs were also asked to express their interest in being involved in prospective trials evaluating post-operative ultra-hypofractionated RT (ultra-HF). Results: One hundred and twenty/183 (65.6%) centres answered the survey. Regarding WBI 99.1% of ROs prescribed moderate hypofractionated (HF) RT and 70.3% ultra-HF RT, sequential administration is the preferred choice for delivering tumour bed boost (60.4% of centres). Moderate HF was the preferred choice for CW irradiation and RNI in 60.3% and 63.6% of centres, respectively. PBI was adopted in clinical practice in only 57.5% of centres. Furthermore, 29.1% of centres are already involved and 34.6% would like to be involved in prospective studies evaluating ultra-HF RT. Conclusion: Hypofractionated RT is widely adopted for WBI, while its use in post-mastectomy RT (PMRT) appears uneven. Adoption of ultra-HF RT is high for WBI, but it is not a standard for CW irradiation and RNI. Regarding PBI, the survey highlighted the need for enhanced expertise to improve its adoption.