S1068
Clinical – Upper GI
ESTRO 2026
outcome of neoadjuvant chemoradiotherapy plus surgery (CROSS trial). J Clin Oncol. 2021;39. 4. Tomasello G, Petrelli F, Ghidini M, et al. Tumor regression grade and survival after neoadjuvant therapy in gastro-esophageal cancer. Eur J Surg Oncol. 2017;43(9):1607–16. Keywords: Survival predictor, neoadjuvant therapy, GEJ AC
Digital Poster Highlight 789 Radiotherapy combined with
chemoimmunotherapy in gastric cancer with limited lymph node metastases: Preliminary results of the MIRACLE-G study Menglong Zhou 1 , Jing Guo 2 , Wang Yang 1 , Hui Zhang 1 , Yaqi Wang 1 , Yajie Chen 1 , Jingwen Wang 1 , Lijun Shen 1 , Yan Wang 1 , Juefeng Wan 1 , Shujuan Zhou 1 , Ruiyan Wu 1 , Zhiyuan Zhang 1 , Hongda Pan 2 , Bo Sun 2 , Yantao Duan 2 , Jianpeng Gao 2 , Hong Cai 2 , Guangfa Zhao 2 , Fan Xia 1 , Dazhi Xu 2 , Zhen Zhang 1 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. 2 Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China Purpose/Objective: Systemic therapy is the standard of care for metastatic gastric cancer (GC). However, selected patients with limited metastases may benefit from the addition of local therapies. Building upon chemoimmunotherapy, the addition of radiotherapy may further enhance treatment efficacy through synergistic interactions with immunotherapy. MIRACLE-G was designed to evaluate the efficacy and safety of combined radiotherapy and chemoimmunotherapy in GC patients with limited lymph node metastases (LLNM). Material/Methods: MIRALCE-G was a prospective, single arm, investigator- initiated phase II study. The study enrolled GC patients with LLNM, which was defined as retroperitoneal lymph node metastases (RPLM) alone or RPLM combined with extra-abdominal lymph node metastases (LNM), such as supraclavicular LNM. Eligible patients received hypofractionated radiotherapy targeting the primary tumor and metastatic lesions, followed by SOX/FOLFOX chemotherapy, PD-1 inhibitor (with trastuzumab added for HER2-positive patients). Efficacy assessments were conducted every eight weeks using radiological and serological evaluations. Resectable patients underwent radical gastrectomy with regional lymphadenectomy, while unresectable patients received systemic treatment until disease progression or intolerable toxicity. The primary endpoint was overall survival (OS), and secondary endpoints
Conclusion: NCRT showed higher pathological regression than NCT, although OS was similar. OS correlated with TRG, supporting its prognostic relevance. As TRG was an independent prognostic factor, the higher response with NCRT suggests radiotherapy may still play a role in multimodal therapy. Further large multicenter studies focusing on clinical and biological factors are required to guide personalized treatment selection and optimize therapeutic outcomes. References: 1. Hoeppner J, Brunner T, Schmoor C, et al. Perioperative vs preoperative chemoradiotherapy in esophageal cancer. N Engl J Med. 2025;392(4):323– 35. 2. van Laarhoven H, Verhoeven R, van Berge Henegouwen M, et al. Real-world outcomes of the CROSS regimen in resectable esophageal cancer. Dutch cohort study. 2024. 3. Eyck BM, van Lanschot JJB, Hulshof MCCM, et al. Ten-year
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