At SABCS 2024, several abstracts were dedicated to advances in local therapy for patients with early-stage breast cancer (EBC). An EBCTCG database analysis and the EUROPA trail addressed local therapy in the elderly population. Next, the INSEMA trial assessed whether surgical axillary staging as part of breast-conserving therapy (BCT) can be avoided. Furthermore, the SUPREMO trial evaluated the impact of post-mastectomy radiotherapy (PMRT) on survival in intermediate-risk patients. In addition, the Alliance A221803 trial investigated how to reduce radiation dermatitis, a common source of morbidity seen in patients undergoing radiotherapy (RT). Finally, ultrahypofractionated RT regimens either as whole-breast irradiation or as boost to the lumpectomy cavity were evaluated in two studies.