S748
Clinical - Lung
ESTRO 2026
regression, lower levels of NTR SUV max and NLR are associated with good response to concurrent chemoradiotherapy (OR 0.30 95% CI: 0.13-0.67; p=0.004) and (OR 0.27 95% CI: 0.12-0.59; p>0.001). Conclusion: We demonstrated that the NTR SUV Max can have prognostic value in patients with stage III NSCLC treated with concurrent chemoradiotherapy and was correlated with NLR. Keywords: NSCLC, Concurrent chemoradiotherapy, NTR SUV max Assessing Radiation Pneumonitis Risks Using Fractal Analyses in NSCLC Patients Treated with Curative-Intent Radiotherapy Hakyoung Kim 1 , Jeongeun Hwang 2 , Dae Sik Yang 1 , Song Heui Cho 1 , Young Bum Kim 1 1 Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea, Republic of. 2 Medical IT Engineering, Soonchunhyang University, Asan-si 31538, Chungcheongnam-do, Korea, Republic of Digital Poster 43 Purpose/Objective: This study aimed to utilize complex morphometry analyses methods to assess the risks of radiation pneumonitis (RP) and to propose a quantitative prognostic framework for patients with non-small cell lung cancer (NSCLC) undergoing curative-intent radiotherapy (RT). From our previous studies, we found out that a box-counting fractal dimension (BoxFD), lacunarity, and minimum spanning tree fractal dimension (MSTFD) are potential imaging biomarkers having prognostic power for RP occurrence. Material/Methods: We retrospectively analyzed the medical records of 166 patients diagnosed with NSCLC who received curative-intent RT and had both a pre-treatment diagnostic chest CT scan and a follow-up CT scan within 6 months after completing RT. Among these patients, 85 were treated with definitive RT alone, while 81 underwent concurrent chemoradiotherapy (CCRT). We applied fractal dimension analyses for BoxFD, lacunarity, and MSTFD and followed up on the changes in these imaging biomarkers after RT. Subsequently, we built a random forest model (RFM) to predict RP of grade ≥ 2 and to deduce important features. Selecting the features with the highest importances, a decision tree model was built, and its prediction performance was assessed. Results: RP of grade ≥ 2 occurred in 19 patients (22.3%) treated with RT alone and in 44 patients (54.3%) who received
Digital Poster 23
The prognostic value of NTR SUV max and its correlation with NLR in patients with NSCLC treated with CCRT Halil Ashimov 1 , Maria Mihaylova-Hristoma 2 , Emilia Barsha 3 , Hristo Spasov 4 , Rostislav Manev 5 , Kiril Zhelev 3 1 Nuclear Medicin, University Hospital Deva Maria, Burgas, Bulgaria. 2 Nuclear Medicine, National Oncology Hospital, Sofia, Bulgaria. 3 Radiotherapy, University Hospital Deva Maria, Burgas, Bulgaria. 4 Medical Oncology, University Hospital Deva Maria, Burgas, Bulgaria. 5 Medical Oncology, University Hospital St.Marina, Varna, Bulgaria Purpose/Objective: Non-small cell lung cancer (NSCLC) is a highly heterogeneous subtype of lung cancer, and there are still no widely accepted prognostic parameters for stage III. In this study, we evaluated the prognostic value of the standardized uptake value SUV max ratio of lymph node to primary tumor (NTR SUV max) and its correlation with neutrophil to lymphocyte ratio (NLR) in patients with NSCLC treated with concurrent
chemoradiotherapy. Material/Methods:
In this retrospective study, we performed an analysis of 99 patients with NSCLC, 70 (70.7%) men and 29 (29.3%) females, treated with concurrent chemoradiotherapy. The NTR SUV max was calculated by dividing the SUV max of the lymph node by the maximal SUV max of the primary tumor. The cut-off value for NTR SUV max was determined by receiver operating characteristic analysis. Overall response rate (ORR) is the proportion of patients who had a partial or complete response to the treatment. A p-value<.05 was considered statistically significant. Results: The cohort included 66 (66.7%) patients with adenocarcinoma, 30 (46.9%) with squamous cell carcinoma, and 3 (3%) with other histopathology subtypes. ORR was 44.4%. Between all clinicopathological characteristics such as gender, age, histology, time to progression etc. we found no significant relationship except for T-stage (p>0.001), N- stage (p=0.006), ECOG (PS) (p>0.001), NTR SUV max (p>0.001) and NLR (p>0.001) (Chi-Square). Patients who responded to concurrent chemoradiotherapy had a significantly lower NTR SUV max, than those who did not respond (0.36±0.24 vs 0.65±1.21; p>0.001). At the optimal cut-off values for NTR SUV max, the biomarker could significantly and excellently distinguish between patients with or without response (AUC = 0.90, 95% confidence interval (CI) = 0.83–0.96; p > 0.001), with a sensitivity of 74.5% and a specificity of 88.6%. There was a correlation between NTR SUV max and NLR (rho: 0.344, p>0.001). Moreover, in multiple binary logistic
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