S1076
Clinical – Upper GI
ESTRO 2026
younger patients with esophageal cancer treated with definitive concurrent chemoradiotherapy (dCCRT) based on a large, multicenter real-world dataset from TriNetX. Material/Methods: Data were obtained from the TriNetX U.S. Collaborative Network, encompassing 69 healthcare organizations. Patients with esophageal cancer treated with dCCRT between 2010 and 2024 were identified and categorized as elderly ( ≥ 65 years) or younger (<65 years). Propensity score matching (1:1) was applied to balance baseline characteristics. Overall survival (OS) was the primary endpoint; recurrence-free survival (RFS), metastasis-free survival (MFS), and radiation pneumonitis were secondary endpoints. Kaplan–Meier and Cox proportional hazards models were used for survival analyses. Results: A total of 3,826 matched patients (1,913 per group) were analyzed. After matching, baseline characteristics were well-balanced. The median survival was 1,466 days for younger patients and 1,156 days for elderly patients, corresponding to 5-year OS rates of 48.6% and 44.6%, respectively (log-rank p = 0.011). Elderly patients demonstrated superior RFS (5-year, 25.6% vs 21.3%; p <0.001) and MFS (5-year, 53.6% vs 46.5%; p < 0.001). The incidence of radiation pneumonitis was low and comparable between the younger and elderly groups, respectively (2.1% vs 3.3%; HR, 1.8; 95% CI, 1.1–2.8; p = 0.09). Conclusion: In this large real-world cohort, younger patients achieved slightly better OS, whereas elderly patients achieved similar tumor control with acceptable toxicity. Chronological age alone should not preclude curative-intent dCCRT when patients are appropriately selected and managed. References: 1. Al-Kaabi A, Baranov NS, van der Post RS, Schoon EJ, Rosman C, van Laarhoven HWM, et al. Age-specific incidence, treatment, and survival trends in esophageal cancer: a Dutch population-based cohort study. Acta Oncol. 2022;61(5):545-52.2. Linde P, Mallmann M, Adams A, Wegen S, Rosenbrock J, Trommer M, et al. Chemoradiation for elderly patients (>/= 65 years) with esophageal cancer: a retrospective single-center analysis. Radiat Oncol. 2022;17(1):187.3. Bostel T, Akbaba S, Wollschlager D, Mayer A, Nikolaidou E, Murnik M, et al. Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly. Front Oncol. 2023;13:1063670. Keywords: esophagus cancer, CCRT, elders
volume that subtracted the stomach plus 5–10 mm, and the duodenum plus 3–5 mm margins, the small intestine and colon plus 0–5 mm from PTV. The prescription dose was specified as D95% to PTV–PRV= 45–51 Gy, and D98% to PTV ≥ 36 Gy. Overall survival (OS), progression-free survival (PFS), local control (LC), gastrointestinal (GI) adverse event rates, and prognostic factors for OS were examined. OS, PFS, and LC were calculated by the Kaplan-Meier method from the start date of the first treatment. Toxicities were scored by CTCAE ver. 4.0. Prognostic factors for OS were evaluated with the log-rank test. Results: Eighty-four patients were analyzed. Forty-six patients were male, median age was 69 years (41–86), and the primary tumor was located at pancreatic head/body/tail in 46/34/4. The median tumor diameter was 32.5 mm (10–70), and T/N stage was T4N0/T4N1 in 72/12 (UICC 8th edition). Prescribed doses were 45/48/51 Gy in 4/76/4, IC with single/multiple agents was 51/33, and concurrent chemotherapy was gemcitabine/S-1 in 78/6. The first recurrence site was the locoregional recurrence/distant metastasis/both in 14/45/7. Median survival time/2-year OS/PFS/LC rate were 21.5 months/44.6%/25.5%/66.9%. As for GI adverse events ≥ grade 3, acute grade 3 anorexia was observed in 3 patients, and late grade 3–4 GI bleeding was observed in 3 and 2 patients, respectively. While age, sex, tumor diameter, tumor site, and the number of IC course were not associated with OS, CA19-9 level >400 U/mL at the initial diagnosis, CA19-9 level >250 U/mL after IC, IC with a single agent, and LN metastasis were significant prognostic factors for poor OS. Conclusion: MHF-IMRT for LAPC showed favorable outcomes. Elevated CA19-9 levels, IC with a single agent, and LN metastasis were suggested to be prognostic factors for poor OS. Keywords: pancreatic cancer, IMRT, hypofraction Poster Discussion 1795 Age-Related Outcomes After Definitive Chemoradiotherapy for Esophageal Cancer: A Multicenter Real-World Analysis Mau-Shin Chi 1 , Hui-Ling Ko 1 , Ya-Fang Liu 2 , Kwan-Hwa Chi 1 1 Department of Radiation Therapy & Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. 2 Department of Research, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan Purpose/Objective: To evaluate survival, recurrence, metastasis, and pulmonary toxicity outcomes between elderly and
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