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Menglan Zhai,1,* Jianping Bi,1,* Zirui Ke,2,3,* Min Hu,4 Guoliang Pi,1 Ying Li,1 Hanping He,1 Yanping Li,1 Hongmei Zheng,2,3 Xinhong Wu,2,3 Vivek Verma,5 Jun Shao,2,3 Guang Han1 1Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 2Department of Breast Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, National Key Clinical Specialty, Wuhan, Hubei, People’s Republic of China; 3Wuhan Clinical Research Center for Breast Cancer, Hubei Provincial Clinical Research Center for Breast Cancer, Wuhan, Hubei, People’s Republic of China; 4Department of Pathology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 5Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA*These authors contributed equally to this workCorrespondence: Guang Han, Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China, Tel +86-27-8767-0023, Email hg7913@hotmail.com Jun Shao, Department of Breast Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, National Key Clinical Specialty, Wuhan, Hubei, People’s Republic of China, Tel +86-27-8767-0051, Email 39390822@qq.comPurpose: The combination of radiotherapy with immunotherapy holds synergistic potential, yet its role in the neoadjuvant treatment of breast cancer remains underexplored. This single-center, retrospective pilot study aimed to explore the preliminary efficacy and safety of integrating stereotactic body radiotherapy (SBRT) with chemoimmunotherapy as a novel neoadjuvant regimen for a small cohort of patients with high-risk, locally advanced breast cancer.Patients and Methods: Between June 2023 and August 2025, 20 patients received neoadjuvant SBRT (18Gy/3 fractions for node-positive; 24Gy/3 fractions for node-negative disease) concurrently with chemoimmunotherapy (various anti-PD-1/bispecific antibodies plus chemotherapy), followed by surgery. Key endpoints were pathological complete response (pCR, ypT0/Tis ypN0), near-pCR (Residual Cancer Burden [RCB] class 0 or I), objective response rate (ORR), and safety.Results: The cohort included triple-negative breast cancer (TNBC, 35%) and hormone receptor-positive/HER2-negative breast cancer of the Luminal B subtype (Luminal B/HER2-, 50%). Most had cT2 (75%) and node-positive (75%) disease. The median number of chemoimmunotherapy cycles were 8, with 80% receiving an AC-T backbone. The overall pCR rate was 45% (9/20). Efficacy varied by subtype: the pCR rate was 85.7% (6/7) in TNBC and 20% (2/10) in Luminal B/HER2- disease. Notably, 100% of TNBC and 40% of Luminal B/HER2- patients achieved near-pCR (RCB 0/I). ORR was 90%. Grade 3– 4 adverse events occurred in 25% of patients, with no treatment-related mortality.Conclusion: In this single-center, retrospective pilot study, early integration of SBRT with chemoimmunotherapy demonstrated promising antitumor activity, particularly high pCR rates in TNBC and induction of deep pathological responses (RCB 0/I) in Luminal B/HER2- disease, with a manageable safety profile. Observed in a heterogeneous cohort, these preliminary findings highlight potential efficacy but require cautious interpretation and warrant validation in larger, prospective trials.Keywords: breast cancer, neoadjuvant therapy, stereotactic body radiotherapy, immunotherapy, pathological complete response