S1125
Clinical – Upper GI
ESTRO 2026
2017;43:696–702. https://doi.org/10.1016/j.ejso.2016.11.013.2 Kutcher GJ, Burman C. Calculation of complication probability factors for non-uniform normal tissue irradiation: the effective volume method. Int J Radiat Oncol Biol Phys 1989;16:1623–30. https://doi.org/10.1016/0360- 3016(89)90972-3. Keywords: Esophageal cancer, NTCP, Pulmonary complications Multi-institutional clinical outcomes of ablative MR-guided radiotherapy for inoperable pancreatic ductal adenocarcinoma Mohemed Schumann 1,2 , Luca Boldrini 3,4 , Riccardo D'Angelo 3,4 , Lena Kretzschmar 5 , Panagiotis Balermpas 5 , Philipp Hoegen 6 , Sebastian H Maier 1 , Ann S Zimmermann 1 , Frederik Fuchs 1 , Sebastian N. Marschner 1,7 , Chukwuka Eze 1 , Franziska Walter 1 , Claus Belka 1,2 , Stefanie Corradini 1,8 , Paul Rogowski 1 1 Department of Radiation Oncology, LMU University Hospital, Munich, Germany. 2 Bavarian Cancer Mini-Oral 4945 Research Center (BZKF), Partner Site Munich, Munich, Germany. 3 Department of Diagnostic imaging and Radiation Oncology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy. 4 Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, Rome, Italy. 5 Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland. 6 Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany. 7 German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany. 8 Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Erlangen, Germany
validation performance: AUC=0.720 and calibration slope=0.851.The respiratory failure risk gradually increases with smaller LungVS15a (Figure 1). LungVS15a significantly improved the logistic model fit compared to MLD and Deff(p=0.030 and p=0.029 respectively, likelihood ratio test). Table 1 represents the logistic model for respiratory failure using MLD, Deff and LungVS15a. The LungVS15a model intercept was updated based on validation data (closed testing procedure). The optimal LungVS15a cutoff was 2192.5 cm3.
Purpose/Objective: Prognosis of inoperable pancreatic ductal
adenocarcinoma (PDAC) remains poor, and safe delivery of ablative radiation doses has historically been challenging. Magnetic resonance-guided radiotherapy (MRIgRT) enables daily online adaptation and real-time motion management, allowing precise tumor targeting and improved organ-at-risk (OAR) sparing in the motion-prone upper abdomen. This study reports clinical outcomes after 5-fraction MRIgRT for inoperable PDAC within the European multicentric Radiation Analysis of MR-guided Therapy of the Pancreas (RAMP) consortium. Material/Methods: Patients with non-metastatic PDAC treated with MRIgRT on 0.35-Tesla MR-Linacs across four institutions in Germany, Switzerland, and Italy between April 2019 and July 2025 were retrospectively
Conclusion: This study successfully developed and externally validated an NTCP model for respiratory failure. The clear LungVS15a dose-volume-response observed was found to outperform MLD or Deff. Total lung volumes spared from low-to-moderate dose levels should be considered in treatment planning for EC. Patients with smaller spared lung volumes should be followed closely for respiratory failure risk as their healthy lung capacity after nCRT may not safely allow the invasive surgery. References: 1 Goense L, van Dijk WA, Govaert JA, van Rossum PSN, Ruurda JP, van Hillegersberg R. Hospital costs of complications after esophagectomy for cancer. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol
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