S1082
Clinical – Upper GI
ESTRO 2026
p = 0.03; Figure 1b). Figure 2 shows ALBI grade shifts from baseline to worst observed. Among Δ GALBI>0, 55% occurred during chemotherapy. Of Δ GALBI>0 group, 44.8 % experienced GINF ≥ 3, versus 22.5 % in Δ GALBI=0. Mean liver BED did not differ by infection severity (34.9Gy [GINF<3] vs 29.7Gy [GINF ≥ 3]; p=0.3) or by Δ GALBI groups (32.8 Gy [ Δ GALBI=0] vs 32.5Gy [ Δ GALBI>0]; p = 0.95).
Conclusion: In locally advanced cholangiocarcinoma, both serious liver infections and a rise in ALBI grade predict worse overall survival unexplained by the radiation dose to uninvolved liver. These complications create competing risks that can blunt any apparent benefit of aggressive local therapy such as SBRT on local tumour control. Future SBRT trials might prospectively restrict enrolment by liver function and infection status and embed early detection and management pathways for sepsis and deranged liver function to optimise net clinical benefit. References: [1] Omouri-Kharashtomi, M., Alemohammad, S.Y., Moazed, N. et al. Prognostic value of albumin-bilirubin grade in patients with cholangiocarcinoma: a systematic review and meta-analysis. BMC Gastroenterol 25, 19 (2025). https://doi.org/10.1186/s12876-025-03596-6 Keywords: cholangiocarcinoma, infections, liver- function Digital Poster 2242 Clinical Characteristics and Outcomes of Nonagenarian Hepatocallular Carcinoma Patients Treated with Proton Beam Therapy: Bi- Institutional Study Takashi Iizumi 1 , Nobuyoshi Fukumitsu 2 , Toshiki Ishida 1 , Masahiko Harada 1 , Masaaki Goto 1 , Takuya Sawada 1 , Taisuke Sumiya 1 , Takashi Fujisawa 1 , Keiichiro Baba 1 , Masatoshi Nakamura 1 , Takashi Saito 1 , Haruko Numajiri 1 , Masashi Mizumoto 1 , Kei Nakai 1 , Toshiyuki Okumura 3 , Hideyuki Sakurai 1 1 Radiation Oncology, University of Tsukuba Hospital, Tsukuba, Japan. 2 Radiation Oncology, Kobe Proton Center, Kobe, Japan. 3 Radiation Oncology, Ibaraki Prefectural Hospital, Tomobe, Japan Purpose/Objective: The optimal management of hepatocellular carcinoma (HCC) in nonagenarian patients ( ≥ 90 years) remains challenging due to cumulative comorbidities and concerns regarding treatment tolerance. Proton Beam Therapy (PBT) offers superior normal tissue sparing,
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