S736
Clinical – Lower GI
ESTRO 2026
Digital Poster Highlight 4147
N+. Of the patients, 35 received adjuvant and 42 neoadjuvant RT. Median RT dose was 50.4 Gy (25-56). Serum albumin (ALB), alkaline phosphatase (ALP), neutrophil (N), lymphocyte (L), and lactate dehydrogenase (LDH) values obtained from routine blood tests at the time of diagnosis before any treatment were recorded. CII was scored as good, intermediate, and poor based on LDH and N/L ratio. Mann-Whitney U test, Chi-Square test, ROC analysis, Kaplan-Meier method, and Log Rank test were used for statistical analyses. Results: Median age was 61 (34-89). Median progression-free survival (PFS) and overall survival (OS) were 26.1 (3.27- 56.2) and 30.1 (3.4-58.6) months, respectively. Metastasis/recurrence was observed in 18 patients. Mean±SD of ALB/ALP was found significantly lower in patients with metastasis/recurrence (0.499±0.16 vs. 0.598±0.16, p=0.018). The cut-off value for ALB/ALP to predict metastasis/recurrence was 0.53 [AUC=0.697, p=0.012, 95% CI (0.557-0.837); sensitivity: 78%, specificity: 64%]. Patients with higher ALB/ALP had better PFS when compared to lower ALB/ALP (44.4 vs. 31.7 months, p=0.008). However, OS was not found to be associated with ALB/ALP (p>0.05) (Figure 1). Median PFS in patients with good, intermediate, and poor CII scores were 49.8, 40.5, and 21.6 months, respectively. PFS was significantly decreased in patients with poor CII scores (p=0.019). There was not a relationship between CII scores and OS (p>0.05) (Figure 2).
THUNDER-2 an escalating radiation therapy dose trial in non-responder patients affected by rectal cancer: an interim quality of life (QoL) analysis Isabella Costamagna 1 , Flavia De Giacomo 2 , Angela Romano 2 , Filippo Quattrocchi 1 , Natalia Barogi 2 , Luca Boldrini 2 , Giulia Panza 2 , Carlo Guglielmo Cattaneo 1 , Elisa Meldolesi 2 , Stefania Manfrida 2 , Maria Antonietta Gambacorta 2 , Giuditta Chiloiro 2 1 Radiology, Radiation Oncology and Hematology Department, Catholic University of the Sacred Heart, Rome, Italy. 2 Radiology, Radiation Oncology and Hematology Department, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy Purpose/Objective: Management of locally advanced rectal cancer (LARC) typically involves radio-chemotherapy (RTCT) followed by surgery or non-operative management (NOM), such as watch and wait or local excision, depending on the response to RTCT. These treatments can significantly impact patients’ QoL which is increasingly central to personalized cancer therapy. This analysis focus on QoL outcomes from the THUNDER-2 trial1 which investigate the benefits of MRI-guided radiotherapy (RT) dose escalation in non-responder LARC patients. Material/Methods: Forty patients were enrolled and completed four QoL questionnaires: EORTC QLQ-C30 to measure general cancer QoL; EORTC QLQ-CR29 evaluating colorectal cancer patients QoL; Bowel Function Index (BFI); International Index of Erectile Function (IIEF) and Female Sexual Function Index (FSFI). Assessments were performed at baseline pre-RT, at 1 and 2 years of follow-up (FUP). Results: BFI was filled out by 40 patients pre-RT and by 36 patients at 1-year FUP. BFI analysis revealed that NOM patients showed a trend toward improved evacuation function over time, while surgical patients experienced a deterioration, particularly in complete evacuation within 15 minutes (p=0.01). Bowel frequency (p=0.04) and complete evacuation efficiency (p=0.04) improved at 1-year FUP in NOM patients. No significant differences were found across other BFI subscales. The RT boost administration was not associated with a significant change in BFI between baseline and the 1- year FUP. QLQ-C30 and QLQ-C29 were respectively completed at 1-year by 21 and 22 patients. Results show an excellent recovery of role and social functioning at 1-year. However, bowel dysfunction and fatigue mainly impact patients’ life. For both questionnaires, males showed better recovery in physical performance (QLQ-C29 p=0.05) and functional role, however global QoL was similar between sexes. No significant sex differences were found in bowel
Figure 1: Survival analysis based on ALB/ALP: (A) PFS and (B) OS
Figure 2: Survival analysis based on CII scores: (A) PFS and (B) OS Conclusion: ALB/ALP and CII scores may help to predict progression in patients with locally advanced rectal cancer treated with neoadjuvant/adjuvant RT. Keywords: Rectal cancer, progression, inflammatory markers
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