Humeral heads can be unintentionally exposed during breast radiotherapy, particularly when regional lymph nodes are targeted. Moreover, rotational intensity-modulated radiation therapy techniques, such as helical tomotherapy (HT), increase the low-dose bath, the consequences of which are subject to debate. The aim of this study was to analyze late adverse events involving humeral heads occurring after adjuvant locoregional breast radiotherapy with HT. This single-center retrospective study included 159 breast cancer patients locoregionally irradiated, including the regional lymph nodes, in an adjuvant setting with HT at Institut Curie (Paris, France), between January 2010 and 2016. After a median delay of 48 months, six patients (3.8%) developed localized bone pain, three (1.9%) developed a shoulder functional limitation and one (0.6%) developed a traumatic humeral head fracture. The average mean and maximum doses to humeral heads were 9.18 Gy and 24.41 Gy, respectively, and were not statistically associated with humeral head adverse events. Adverse events were statistically more frequent after mastectomy than after breast-conserving surgery. Berg’s level 1 and 2/3 irradiation, and right-sided radiotherapy were associated with an increased maximum dose. In summary, clinical adverse events were rare, and radiation exposure to humeral heads was low. No correlation was found between dosimetric parameters and late toxicity.

Palbociclib (Ibrancem) has been marketed since 2015 for patients with metastatic hormone-receptorpositive breast cancer. We report here the case of a patient who presented with a posterior reversible encephalopathy syndrome (PRES) during treatment with this new targeted therapy. The 67-year-old woman presented prodromal headaches followed by occurrences of two episodes of generalized convulsive seizures. The brain MRI revealed a bilateral, globally symmetrical, sub-cortical parietooccipital fluid-attenuated inversion recovery (FLAIR) hypersignal of the white matter. The patient recovered after palbociclib discontinuation with no further neurological signs. A follow-up MRI performed one month upon palbociclib discontinuation showed a decrease in the FLAIR signal abnormalities. Altogether, the clinical presentation was consistent with PRES. This case report aims to encourage physicians whom patients are treated with cyclin-dependent kinase 4/6 inhibitors to cautiously monitor symptoms suggesting PRES in contexts known to promote its occurrence such as that of arterial hypertension, immunosuppression, and/or autoimmune disease. PRES should be considered in the event of seizure, headache, and/or visual disturbances.

Bilateral adrenal metastases are rare but clinically significant. While stereotactic body radiotherapy (SBRT) provides excellent local control, the risk of post-treatment primary adrenal insufficiency (PAI) after bilateral irradiation remains poorly defined and lacks standardized management guidelines. We performed a comprehensive literature review following PRISMA principles, using PubMed and Embase databases (January 1956 to June 2025). Studies including patients with bilateral adrenal metastases treated with radiotherapy, or unilateral irradiation in the setting of a solitary adrenal gland, were eligible. Data on treatment characteristics, incidence of PAI, diagnostic approaches, and management were extracted. In parallel, a multidisciplinary expert panel developed expert opinion–based practical recommendations for the screening, treatment, and follow-up of PAI. Thirty studies comprising 156 patients treated with bilateral adrenal irradiation (or irradiation of a solitary adrenal gland) were included. PAI was reported in 47 patients (30%), although systematic endocrine evaluation was performed in only a minority of studies, suggesting potential underestimation. Time to onset ranged from 3 to 30 months. Reporting of diagnostic work-up, management, and follow-up was highly heterogeneous, and treatment details were frequently lacking. No study identified reliable dosimetric predictors of PAI, and no association between radiation dose parameters and adrenal insufficiency was demonstrated. PAI following bilateral adrenal radiotherapy is likely under-recognized and under-reported, with clinically meaningful incidence and potential life-threatening consequences. In the absence of robust data, systematic hormonal assessment, careful treatment planning, and structured long-term follow-up are essential. We propose practical, expert-based recommendations to guide clinical management, while emphasizing the need for prospective studies to better define incidence, risk factors, and optimal prevention strategies.