S1078
Clinical – Upper GI
ESTRO 2026
Digital Poster Highlight 1873
The Burden of Radiotherapy on Future Vascular Risk in Esophageal Cancer: A Real-World Evidence Study Jeng-You Wu 1,2 , Chia-Yu Emily Su 2,3 , Min-Huei Hsu 4 1 Radiation Oncology, Wan Fang Hospital, Taipei, Taiwan. 2 Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan. 3 Institute of Biomedical Informatics, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. 4 Graduate Institute of Data Science, Taipei Medical University, Taiepi, Taiwan
Purpose/Objective: Radiotherapy (RT) is a key modality in the
management of esophageal cancer (EC), but the full spectrum of its late vascular toxicity, particularly neurovascular complications, remains uncertain. This study aimed to evaluate whether RT for EC is associated with an increased risk of new-onset ischemic heart disease (IHD; ICD-10 I20–I25) and cerebrovascular events (ICD-10 I60–I69), and to characterize the combined burden of coronary and cerebrovascular events in a large, contemporary, real- world cohort. Material/Methods: We performed a retrospective cohort study using the TriNetX US Collaborative Network, including adult patients with EC (ICD-10 C15) and no prior IHD or cerebrovascular disease. The index date was the first EC diagnosis. Patients were assigned to the RT group if they received RT within 6 months of diagnosis and to the non-RT group if they did not. Outcomes were assessed from day 1 after index; patients with events prior to this window or events dated >20 years before index were excluded from relevant analyses. The primary endpoint was new-onset IHD. Secondary endpoints were new-onset cerebrovascular events and a composite of IHD and/or cerebrovascular events. Risk difference (RD), risk ratio (RR), odds ratio (OR), and Kaplan–Meier-based hazard ratios (HR) with log-rank tests were used to estimate associations. Results: We identified 13,209 RT-treated and 57,311 non-RT patients. New-onset IHD occurred in 18.1% vs 13.4% (RD 4.7%, RR 1.35, OR 1.43, HR 1.25; all p<0.001) in the RT and non-RT groups, respectively. Cerebrovascular events occurred in 8.4% vs 5.7% (RD 2.6%, RR 1.46, OR 1.50, HR 1.36; p<0.001). For the composite endpoint, at least one vascular event occurred in 23.2% vs 16.8% (RD 6.4%, RR 1.38, OR 1.50, HR 1.29; p<0.001), indicating a substantial excess vascular burden after RT. Conclusion:
Baseline characteristics (age, gender, ECOG status, T- and N-stage) were similar between groups. The NACRT arm showed higher complete (46.2% vs 8.3%) and partial (53.8% vs 33.3%) response rates, while stable/progressive disease occurred only in the NACT arm (58.3%). This difference was statistically significant (p = 0.003). Surgery was performed in 2 patients per group ( ≈ 16%), with comparable R0/R1 resections and no postoperative complications (Figure 2 Table 1). Despite a 42.3% CR rate, only 15.3% of NACRT patients opted for surgery. Toxicities were largely mild. Thrombocytopenia (Grade 1–2) was more frequent with NACRT (61.5% vs 33.3%), while Grade 3 only with NACT (8.3%, p = 0.45). Rates of anaemia, nausea/vomiting, and radiation gastritis were similar. Gastric stenosis, reported in one NACRT case (7.7%), was not significant (p = 0.327). Quality-of-life outcomes favoured NACRT, with significant improvements in FACT-G (p = 0.028), T-FACT-Hep (p = 0.031) (Figure 2(a)), and in physical, emotional, and functional well-being domains (Figure 1 Tables 2, 3). Median overall survival was longer with NACRT (14.16 months vs 10.46 months; p = 0.03) (Figure 2(b)). Conclusion: NACRT achieved better response, survival, and quality- of-life outcomes than NACT in unresectable LAGB, with manageable toxicity, making it a more effective neoadjuvant option. References: 1. de Groen PC, Gores GJ, LaRusso NF, et al. Biliary tract cancers. NEngl J Med 1999;341:1368-78.2. Engineer R, Wadasadawala T, Mehta S, et al. Chemoradiation for unresectable gall bladder cancer: time to review historic nihilisim? JGastrointest Cancer 2011;42:222-7. Keywords: ca gall bladder, neoadjuvant chemoradiotherapy
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