S1081
Clinical – Upper GI
ESTRO 2026
Proffered Paper 2149 Hepatobiliary infections and liver-function deterioration impact survival in locally advanced cholangiocarcinoma: post-hoc analysis of ABC-07 trial Ying Zhang 1 , Douglas Brand 1,2 , John Bridgewater 3 , Shumona Shelly 4 , Natasha Hava 4 , Ka Man Mak 4 , Memuna Rashid 4 , Charles-Antoine Collins Fekete 1 , Maria A.Hawkins 1,2 1 Medical Physics and Biomedical Engineering, University College London, London, United Kingdom. 2 Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, United Kingdom. 3 Research Department of Haematology, University College London, London, United Kingdom. 4 Cancer Research UK & UCL Cancer Trials Centre, University College London, London, United Kingdom Purpose/Objective: Treatment of cholangiocarcinoma is frequently challenging due to biliary obstruction causing sepsis and deranged liver function. We evaluated the impact of (i) clinically significant (CTCAE Gr3) hepatobiliary infections on overall survival (OS); (ii) Albumin– Bilirubin (ALBI)–based liver function changes on OS; and (iii) whether liver radiation dose was associated with infection severity or ALBI worsening. Material/Methods: We analysed 69 patients enrolled in ABC-07 phase II multicentre randomised trial (ISRCTN:10639376) with inoperable, histologically confirmed locally advanced cholangiocarcinoma. After four cycles of cisplatin– gemcitabine (CisGem), patients without progression were randomised (2:1) to six cycles then stereotactic body radiotherapy (SBRT: n=45, 40–50 Gy in 5 fractions or 45-67.5 Gy in 15 fractions) versus eight cycles of CisGem (n=24, cycles 7–8). Infections/blood tests were recorded at baseline, during treatment, and follow-up. Standard ALBI score and grading was undertaken [1]. Δ GALBI was defined as the worst ALBI grade during treatment/follow-up minus baseline and used to stratify patients into two groups ( Δ GALBI=0versus Δ GALBI>0). Infection (biliary tract infection, infections and infestations, sepsis, and abdominal infection) severity were prospectively graded using CTCAE v4.03 and dichotomised (GINF<3 versus GINF ≥ 3). No covariate adjustment was performed. In the SBRT cohort, we used an independent two-sample t-test to assess whether mean liver biologically effective dose (BED) differed by infection severity or by ALBI changes. Results: Patients with GINF<3 had longer OS than those with GINF ≥ 3 (Log-Rank analysis, p = 0.002; Figure 1a). Among 42 events of GINF ≥ 3, 38% occurred during chemotherapy. Patients with Δ GALBI>0 had worse survival than those with Δ GALBI=0 (Log-Rank analysis,
neoadjuvant CCRT for patients with resectable esophageal squamous cell carcinoma (ESCC). Material/Methods: We retrospectively analyzed 16 patients with resectable ESCC treated between June 2020 and December 2024. The median age was 59.9 years (range, 50.9–71.9), with 14 males and 2 females. The neoadjuvant regimen consisted of 41.4 Gy in 23 fractions delivered concurrently with platinum-based chemotherapy. Regional hyperthermia was administered once weekly for five sessions during CCRT using the Oncotherm EHY-2000+ system. Surgical resection was performed 4–6 weeks after completion of neoadjuvant therapy. Results: All patients underwent R0 resection. A pathological complete response (pCR) was achieved in 10 patients (62.5%), while 6 (37.5%) showed partial responses. No patient demonstrated progressive disease following neoadjuvant treatment. Among 8 patients initially staged as IVA (cT4 or N3), 4 achieved pCR. Treatment was well tolerated, with no grade ≥ 3 toxicities. Reported adverse events included one case of grade 2 esophagitis, nine grade 1 esophagitis, and seven grade 1 dermatitis. At a median follow-up of 13.6 months, no local recurrences were observed, with three patients developed distant metastases. Conclusion: Neoadjuvant CCRT combined with loco-regional hyperthermia was feasible, safe, and yielded a high pCR rate (62.5%) with excellent local control in resectable ESCC. The favorable outcomes observed in stage IVA disease suggest potential benefit in locally advanced tumors, warranting further prospective validation. References: Sugimachi K, Kitamura K, Baba K, Ikebe M, Morita M, Matsuda H, et al. Hyperthermia combined with chemotherapy and irradiation for patients with carcinoma of the oesophagus--a prospective randomized trial. International journal of hyperthermia 1992;8(3):289-95.van der Zee J, Gonzalez Gonzalez D, van Rhoon GC, van Dijk JD, van Putten WL, Hart AA. Comparison of radiotherapy alone with radiotherapy plus hyperthermia in locally advanced pelvic tumours: a prospective, randomised, multicentre trial. Dutch Deep Hyperthermia Group. Lancet. 2000;355(9210):1119-25. Keywords: esophagus cancer, hyperthermia, CCRT
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