S1374
Interdisciplinary - Global health
ESTRO 2026
Purpose/Objective: Stereotactic radiosurgery (SRS) is increasingly used for the management of brain metastases, yet regional data from the Middle East are limited. This study reports the first national Palestinian experience with SRS for brain metastases, evaluating clinical outcomes, prognostic factors, and feasibility of implementing advanced radiotherapy in a resource-limited setting. Material/Methods: Thirty-six patients with 51 brain metastases were treated with single-fraction SRS (20 Gy) between April 2019 and August 2024. Dose prescription followed two
most frequent diagnosis (42 patients; 60%). All participants completed the validated Arabic version of the Patient Health Questionnaire (PHQ-9), assessing depressive symptom severity (0–3 per item). Depression was classified as mild (5–9), moderate (10– 14), moderately severe (15–19), or severe (20–27). A psycho-oncology consultation was systematically proposed for scores ≥ 5, and non-attendees were contacted to explore reasons for non-consultation. Results: The median PHQ-9 score was 4 [0–27]; 22 patients (31.4%) had scores ≥ 10, indicating clinically significant depressive symptoms. Moderately severe depression was observed in 6 patients (10%) and severe depression in 13 (18.6%). Suicidal thoughts occurred in 6 patients (8.6%), including two with a suicide plan and one prior attempt. Furthermore, five patients (7,1%) expressed death wishes. Functional impairment was substantial, with 30% reporting marked or extreme limitation in daily activities and 8.6% experiencing family or marital conflicts. A psycho-oncology consultation was recommended for 38 patients (45.7%) but declined upfront by two; only 14 (38.8%) attended. The main barriers were lack of perceived need (31.8%), financial constraints (13.6%), and geographic distance (9%). Among those assessed, 6 (42.8%) met DSM-5 criteria for major depressive disorder, 2 (14.3%) had bipolar disorder, and 5 (35.7%) adjustment disorder; 9 patients (62.3%) initiated pharmacologic treatment. Conclusion: Depressive symptoms were highly prevalent among patients receiving radiotherapy, with one in five experiencing moderately severe to severe forms. Yet, fewer than 40% of referred patients attended psycho- oncology consultations. These findings highlight the urgent need to integrate systematic depression screening into oncology workflows and to implement targeted interventions addressing financial, geographic, and perceptual barriers to psycho- oncological care. Keywords: Depression screening, Radiotherapy Stereotactic radiosurgery for brain metastases in Palestine: first nationwide study in a resource- limited setting Elias Edward Lahham 1 , Motaz Saifi 2 , Mohammad Amro 2 , Ahmed Sawafta 2 , Mohammad juabeh 2 , Fadi Basha 2 , Ibrahem Eid 1 , Muath Badawi 1 , Salem Billan 1 , Fadi Atrash 1 1 Radiation Oncology Department, Augusta Victoria Hospital, East Jerusalem, Palestine. 2 Faculty of Medicine, An Najah National University, Nablus, Palestine Digital Poster 4754
approaches: 20 Gy to the 80% isodose line (Dmax = 25 Gy) or 20 Gy defined as D98 with
D0.03 cc = 24–25 Gy. Kaplan–Meier survival analysis and Cox proportional hazards models estimated LPFS and OS. Variables analyzed included age, Karnofsky Performance Status (KPS), recursive partitioning analysis (RPA) class, diagnosis-specific graded prognostic assessment (GPA), gross tumor volume (GTV), and histology. Results: Breast cancer was the most common primary tumor (41.7%), followed by non-small cell lung cancer (NSCLC) adenocarcinoma (30.6%). The median gross tumor volume (GTV) was 1.65 cm ³ (IQR 1.0–2.0). With a median follow-up of 22 months (range, 6–60 months), the median overall survival (OS) was 20.5 months (IQR 12.0–35.0), and the median local progression-free survival (LPFS) was 15.0 months (IQR 11.5–24.5). Twelve- and 24-month LPFS rates were 62.5% and 40.1%, respectively. On first follow-up MRI, 61.1% of lesions showed partial or complete response, 36.1% were stable, and 2.8% progressed. Multivariate analysis showed no significant effect of GTV (HR = 0.18; p = 0.31) or histology (HR = 1.18; p = 0.92) on OS, while RPA class (HR = 0.03; p = 0.09) demonstrated borderline prognostic value. LPFS was not significantly influenced by age, KPS, or tumor volume.
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