Peer-Reviewed Publication
Radiother Oncol2026;214111236.January 1, 2026Journal Article

ESTRO recommendations on preoperative radiation therapy in breast cancer: current and future perspectives - Endorsed by ASTRO.

Alice Zamagni1, Angel Montero Luis2, Ingvil Mjaaland3, Monica Emilia Chirila4, Raquel Ciervide2, Melanie Machiels5, Ivica Ratosa6, Desiree H J G Van Den Bongard7, Marianne Aznar8, Liesbeth J Boersma9, Charlotte E Coles10, Stefanie Corradini11, Alex De Caluwe12, Dorota Gabrys13, Orit Kaidar-Person14, Anna M Kirby15, David Krug16, Maja V Maraldo17, Icro Meattini18, Sofia Rivera19, Navita Somaiah15, Vratislav Strnad20, Youssef Zeidan21, Philip Poortmans5
1Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy. Electronic address: alice.zamagni@ausl.re.it.
2Department of Radiation Oncology, HM Hospitales, Faculty of Health, Universidad Camilo José Cela, Madrid, Spain.
3Department of Radiotherapy, Stavanger University Hospital, Stavanger, Norway.
4Department of Radiation Oncology, Amethyst Radiotherapy Centre, Cluj-Napoca, Romania; Department of Clinical Development, MVision AI, Helsinki, Finland.
5Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium.
6Division of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
7Department of Radiation Oncology, Amsterdam UMC/Cancer Center Amsterdam, Cancer Treatment and Quality of Life/Cancer Biology and Immunology, Amsterdam, the Netherlands.
8Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
9Department of Radiation Oncology (Maastro), GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands.
10Department of Oncology, University of Cambridge, Cambridge, UK.
11Department of Radiation Oncology, University Hospital Munich, LMU Munich, Munich, Germany.
12Department of Radiation Oncology, Jules Bordet Institute, Brussels, Belgium.
13Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland.
14Radiation Oncology Unit, Sheba Medical Center, Ramat-Gan, Israel; Tel Aviv Medical School, Tel Aviv University, Israel.
15Division of Radiotherapy and Imaging, Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK.
16Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany.
17Department of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; (j)Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
18Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit & Breast Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
19Radiotherapy Department, Gustave Roussy, Paris-Saclay University, F-94805 Villejuif, France.
20Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; CCC Erlangen-EMN, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.
21Department of Radiation Oncology, Lynn Cancer Institute, Boca Raton Regional Hospital, Baptist Health South Florida, Boca Raton, FL, USA.

Abstract

BACKGROUND AND PURPOSE: Preoperative radiation therapy (RT) for breast cancer is not a novel concept, though available data are insufficient to translate current knowledge into clinical practice. Nonetheless, potential advantages of this approach are emerging in multiple scenarios, incorporating increasing treatment personalization and technological improvements in RT. This paper aims to synthesiz…

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