S1083
Clinical – Upper GI
ESTRO 2026
Proffered Paper 2260
potentially making it ideal for this frail population. This study assesses the feasibility, safety, and clinical outcomes of PBT in nonagenarian HCC patients. Material/Methods: We retrospectively analyzed n = 22 consecutive patients aged ≥ 90 years who underwent definitive PBT at two institutions between 2000 and 2023. Baseline characteristics, including Child-Pugh class, modified ALBI (mALBI) score, BCLC stage, Charlson Comorbidity Index (CCI), were recorded. The PBT dose regimen was typically hypofractionated, delivering a median total dose of 72.6 Gy (RBE) in a median of 22 fractions. Primary endpoints were overall survival (OS), progression-free survival (PFS), cumulative incidence of local recurrence (CILR) and Grade ≥ 3 treatment- related adverse events (AE). Results: The final cohort included n = 22 patients. The median age was 91 years (range, 90-96). The median CCI score was 2 (IQR: 1-5), suggesting low-to-moderate burden of comorbidity. Etiologies were distributed as HBV: 9.1%, HCV: 18.2%, and non-B non-C: 54.5%. The majority of patients had well-preserved liver function (Child-Pugh A: 90.9%). The distribution of liver function according to the mALBI score was Grade 1: 45.5%, Grade 2a: 40.9%, Grade 2b: 13.6%. The median performance status (ECOG) was 1. Overall, 68.1% had ECOG 1/2. The need for a family or other person to accompany the patient to outpatient visits was observed in 19 patients (86.4%). Hospitalization during the PBT course was required for 9 patients (39.1%). Tumor characteristics included a median size of 6.25 cm, with 68.1% of patients presenting with BCLC stage B disease. The median follow-up time for surviving patients was 15 months. The 1-year and 2-year OS rates were 87.5% and 72.3%, respectively, with a median OS of 35 months. Corresponding PFS rates were 58.2% and 41.1%, respectively, with a median OS of 15 months. The 2-year CILR was 11.1%. No patients experienced a Grade ≥ 3 AE. Of the deaths observed, 66.7% were non-liver-related. There were no cases of classic radiation-induced liver disease (RILD). Conclusion: PBT demonstrates favorable local control and survival in nonagenarian HCC patients, with an extremely low incidence of severe toxicity. Age alone should not preclude nonagenarians with good performance status and adequate liver reserve from receiving definitive PBT. Further investigation is warranted to incorporate geriatric assessment into selection criteria. Keywords: Nonagenarian HCC, Proton Beam Therapy
Sequential TACE, SBRT, and Anti-PD-L1 plus Anti- CTLA-4 Immunotherapy in Locally Advanced Hepatocellular Carcinoma: Survival Outcome of Phase II Trial Chi Leung Chiang 1 , Stephen Lam Chan 2 , Kenneth Sik Kwan Chan 1,3 , Francis Ann Shing Lee 4 , Keith Wan Hang Chiu 5 , Natalie Sean Man Wong 4 , Landon Chan 2 , Venus Wan Yan Lee 4 , Vanessa Ting Yan Yeung 6 , Ryan Lok Man Ho 7 , Vince Wing Hang Lau 5 , Nancy Kwan Man 8 , Spring Kong 1 , Albert Chi Yan Chan 8 1 Clinical Oncology, The University of Hong Kong, Hong Kong, China. 2 Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China. 3 Faculty of Dentistry, The University of Hong Kong, Hong Kong, China. 4 Clinical Oncology, Tuen Mun Hospital, Hong Kong, China. 5 Diagnostic Radiology, The University of Hong Kong, Hong Kong, China. 6 Clinical Oncology, Prince of Wales Hospital, Hong Kong, China. 7 Radiotherapy and Oncology Department, Gleneagles Hospital, Hong Kong, China. 8 Surgery, The University of Hong Kong, Hong Kong, China Purpose/Objective: We have previously reported promising early efficacy treatment outcome after sequential transarterial chemoembolization and stereotactic body radiotherapy followed by immunotherapy (START-FIT) using anti-PD1 / PD-L1 in locally advanced HCC (Lancet Gastroenterology and Haptology). Here we aim to evaluate the long-term outcomes of this START-FIT regimen using anti-PD-L1 and anti-CTLA-4 immunotherapy backbone. Material/Methods: Patients with locally advanced unresectable HCC not suitable for curative surgery were prospectively recruited. Eligible patients were those aged 18 years or older, tumor size of at least 5cm, a maximum of three tumor nodules, and child-Pugh A5-B7 liver function. Tumours with extra-hepatic metastasis, main portal vein (VP4) invasion were excluded. Patients underwent single episode of TACE, 5-fraction SBRT (27.5-40 Gy in 5 fractions) at 28 days afterwards, followed by single Tremelimumab (300mg) regular interval Durvalumab (1500mg) at 7 days upon completion of SBRT and every 4 weeks thereafter. The primary endpoint was overall response rate (ORR) per modified Response Evaluation Criteria in Solid Tumors (mRECIST) version 1.1. Survival outcomes were analysed, including progression-free survival (PFS), overall survival (OS), local control (LC) rate, and treatment-related adverse event (TRAE) [NCT 04988945].
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