ESTRO 2025 - Abstract Book

S32

Invited Speaker

ESTRO 2025

Abstract:

Many of us are already using AI-based tools in daily clinical practice, and reports of experience after clinical implementation are emerging. In this talk, we will review the use of AI for auto-contouring and auto-planning in breast radiotherapy. We will discuss the performance of current commercial solutions and the evidence in terms of time savings and quality improvement, as well as other potential advantages, e.g. the availability of new OARs such as cardiac subtructures.

In addition, we will discuss the potential of AI tools for large scale audits and data sharing.

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Speaker Abstracts Challenges and opportunities of biomarker-directed optimisation of breast radiotherapy Charlotte E Coles Department of Oncology, University of Cambridge, Cambridge, United Kingdom

Abstract:

Challenges and opportunities of biomarker-directed optimisation of breast radiotherapy

Use of biomarkers to direct systemic therapy for patients with breast cancer is now embedded in standard of care practice. In contrast, biomarker-directed optimisation of breast radiotherapy is much less commonly used outside of research studies. This presentation will start with ‘demystifying’ the topic, by defining and comparing prognostic versus predictive biomarkers, and discussing analytical validity, clinical validity, and clinical utility 1 . It will highlight that most biomarkers are prognostic and describe the necessary requirements to fulfil the definition of a predictive biomarker. It will also address the finding that clinical utility cannot be claimed without both analytical and clinical validation. The challenges of using biomarkers to optimise radiotherapy will be shown. This will include detailed examples for both invasive breast cancer and ductal carcinoma in-situ. Potential opportunities with incorporating biomarkers into breast radiotherapy shared decision making will be illustrated with the wealth of on-going clinical trials. These studies include optimising whole breast and regional node radiotherapy. Caution with a focus on ‘de-escalating’ breast radiotherapy in favour of endocrine therapy will be covered with interim data from the Europa trial. 1. Meattini I, Coles CE, Tramm T, Borghesi S, Krug D, Montero A, Nardone V, Salvestrini V, Valzano M, Valentini V, Aristei C, Poortmans P; Assisi Think Tank Meeting Investigators. Biomarker-Directed Radiotherapy in Breast Cancer: A Narrative Review. JAMA Oncol. 2025 Mar 1;11(3):329-339. doi: 10.1001/jamaoncol.2024.5780. PMID: 39820307.