S751
Clinical - Lung
ESTRO 2026
regimens as a potentially safer alternative in this high- risk anatomical setting. References: Bezjak A, Paulus R, Gaspar LE, Timmerman RD, et al. Safety and efficacy of a five-fraction stereotactic body radiotherapy schedule for centrally located non–small- cell lung cancer: NRG Oncology/RTOG 0813 trial. J Clin Oncol. 2019;37(15):1316-25. Yan M, Louie AV, Kotecha R, et al. Stereotactic body radiotherapy for ultra- central lung tumors: A systematic review and meta- analysis and International Stereotactic Radiosurgery Society practice guidelines. Lung Cancer. 2023;182:107281. Swaminath A, Parpia S, Wierzbicki M, et al. Stereotactic vs hypofractionated radiotherapy for inoperable stage I non–small cell lung cancer: The LUSTRE phase 3 randomized clinical trial. JAMA Oncol. 2024;10(11):1571-5. Keywords: Ultracentral lung cancer, SBRT, Hypofractionation Digital Poster 104 Prophylactic cranial irradiation versus active surveillance in limited-stage small cell lung cancer: a 10-year retrospective analysis Mahbuba Choudhury 1 , Femi Williams Adeoye 1,2 , Chandimal Akurana 1,3 , Princy Biju 4 , Gulshad Begum 1,5 , Mohammad Rafiqul Islam 1,6 1 Oncology Department, Southend University Hospital, Southend-on-Sea, United Kingdom. 2 Oncology Department, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom. 3 Oncology Department, Colchester General Hospital, Colchester, United Kingdom. 4 Internal Medicine Department, Southend University Hospital, Southend-on-Sea, United Kingdom. 5 Oncology Department, Basildon University Hospital, Basildon, United Kingdom. 6 Oncology Department, Broomfield Hospital, Chelmsford, United Kingdom Purpose/Objective: Prophylactic cranial irradiation (PCI) has been the standard of care for limited-stage small cell lung cancer (LS-SCLC) since the 1990s, reducing the risk of brain metastases (BMs) and improving overall survival (OS) in trials. However, its role is increasingly debated due to advancements in MRI surveillance for early BM detection and concerns about neurotoxicity. This 10- year retrospective study compares clinical outcomes in patients with LS-SCLC who were managed with PCI versus active surveillance at a large UK centre. Material/Methods: We analysed 77 patients with LS-SCLC (stages IA-IIIC) who completed thoracic chemoradiotherapy (October 2014–December 2024) without disease progression. Patients were stratified into PCI (n=38; 25 Gy/10
supporting its role as a dynamic biomarker for risk stratification. Keywords: Non-small cell lung cancer, Radiotherapy, mGPS
Digital Poster Highlight 102 Radiotherapy (RT) for Ultracentral Lung Tumors: Balancing Tumor Control and Side Effects Laura P Guzmán-Gómez, Carlos Camacho Fuentes, Leticia Del Campo, Daniel Martínez, Javier Luna Tirado Radiation Oncology, Fundación Jiménez Díaz University Hospital, Madrid, Spain Purpose/Objective: To evaluate clinical outcomes and treatment-related adverse events (AE) in patients undergoing stereotactic body radiotherapy (SBRT) or hypofractionated radiotherapy (HRT) for ultracentral lung lesions, including both primary tumors and metastases. Material/Methods: A retrospective review was conducted of patients with ultracentral lung tumors (planning target volume [PTV] overlaps one or more of the following structures: proximal bronchial tree (PBT), trachea and esophagus) treated between January 2015 and January 2023. Outcomes analyzed included local control (LC), overall survival (OS), and treatment-related AE, graded according to CTCAE version 5.0. Results: Eighty patients (90 lesions) were included, comprising 35 early-stage non-small cell lung cancers (NSCLC) and 45 lung metastases. Median age was 68 years (range, 28–87), 70.8% were male, and 93% had ECOG performance status 0–1. Median tumor size was 3.8 cm. Treatment consisted of SBRT (60 Gy in 8 fractions; 55%) and HRT (60Gy in 15 fractions; 45%). Median follow-up was 106 months (range, 88–124). LC rates at 2, 3, and 5 years were 89.5%, 83.8%, and 76%, respectively. The 5-year OS was 70% for primary tumors and 42% for metastatic lesions. Among patients treated with SBRT, grade 1-2 AE occurred in 35%, and grade 3 in 14%, including dyspnea, pneumonitis, esophagitis and hemoptysis. In contrast, patients receiving HRT experienced lower AE rates: grade 1–2 in 15%, and no grade ≥ 3 events were reported. Conclusion: Radiotherapy for ultracentral lung tumors offers excellent local control and represents a viable treatment option in selected patients. However, SBRT is associated with a significantly higher risk of severe side effects compared to HRT, particularly when critical central structures are involved. These findings highlight the need for cautious patient selection and support the consideration of hypofractionated
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