S758
Clinical - Lung
ESTRO 2026
NG122. NICE; 2024. 2.Navani N, et al. Optimising tissue acquisition and the molecular testing pathway for patients with non-small cell lung cancer: a UK expert consensus statement. Lung Cancer. 2022;172:142–53. 3.UK Lung Cancer Coalition. Faster testing, better outcomes: genomic testing in lung cancer. London: UKLCC; 2025. 4.Taniere P, et al. Landscape of cancer biomarker testing in England following genomic services reconfiguration: insights from a nationwide pathologist survey. J Clin Pathol. 2023;77(7):486– 94.5.Baijal S, et al. Variations in genomic testing in non-small cell lung carcinoma: a healthcare professional survey of current practices in the UK. Oncologist. 2023;28(8):e699–e702. Keywords: Genomics, Turnaround Times, NSCLC Survival outcomes of thoracic radiotherapy (TRT) for extensive-stage small cell lung cancer (ES-SCLC) in the immunotherapy era: A Meta-Analysis Ajay Kumar Kondeti 1 , Chandramouli Ramalingam 1 , Kesava Ramgopal Adavikolanu 2 , Soorej Balan Kaliyath 2 , Abhishek Raghava KS 3 , NagaSai Divya Kari 1 , Ambedkar Yadala 4 , Shoban Babu Varthya 5 1 Radiation Oncology, AIIMS, Bibinagar, Hyderabad, India. 2 Radiation Oncology, AIIMS, Mangalagiri, Mangalagiri, India. 3 Medical Oncology, AIIMS, Mangalagiri, Mangalagiri, India. 4 Radiation Oncology, JIPMER, Pondicherry, India. 5 Pharmacology, AIIMS, Jodhpur, Jodhpur, India Proffered Paper 591 Purpose/Objective: The integration of PD-L1 inhibitors with platinum– etoposide chemotherapy has become the standard of care in extensive-stage small-cell lung cancer (ES- SCLC), improving survival compared with chemotherapy alone. However, most patients continue to relapse within the thorax, raising renewed interest in the role of consolidative thoracic radiotherapy (TRT) following immuno-chemotherapy. While historical randomised data supported TRT after chemotherapy, the benefit in the immunotherapy era remains uncertain. This study provides an updated quantitative synthesis of survival outcomes with TRT after first-line chemo-immunotherapy in ES-SCLC. Material/Methods: A systematic review and meta-analysis were performed following PRISMA guidelines and PROSPERO registration (CRD420251163089). PubMed, Embase, Scopus and Cochrane databases were searched up to October 2025 for retrospective, real- world, or prospective studies comparing first-line chemo-immunotherapy with or without TRT. Extracted endpoints included hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS).
report available to clinical teams[1]. However, performance across NHS hospitals is highly variable, and data covering the true end-to-end pathways are limited. This study evaluated genomic testing TATs across the East Genomic Medicine Service Alliance (GMSA), one of seven genomic services in England, serving a population of 8.3 million. We identified variation in practice and explored factors contributing to delay. Material/Methods: Process-mapping was conducted across 15 NHS hospitals in the East GMSA. Hospital pathology departments provided pre- and post-genomic pathway data, while genomic laboratory hubs supplied laboratory metrics. Data was collected for up to 30 consecutive NSCLC patients per hospital between June and August 2024. Preliminary findings were shared in validation meetings with each hospital to ensure accuracy and representation of local practice. Results: Fourteen hospitals submitted datasets, covering 271 patient pathways. The overall median end-to-end TAT was 26 days. The shortest TATs were usually reported by hospitals undertaking in-house testing or co- located with genomic laboratories, eliminating transport delays. Prolonged TATs were observed in hospitals relying on private providers, outsourcing immunohistochemistry, or sending samples over 40 miles to genomic labs, with a positive correlation between distance and delay[2,3]. Outliers included one hospital with a median TAT of 142 days, where genomic tests were only requested at progression by oncologists. Several centres duplicated molecular assays included within next-generation sequencing panels, adding inefficiency and cost[4,5]. Pathway mapping highlighted inequities in access to cellular pathology genomic centres, with some hospitals unable to provide in-house PD-L1 testing, leading to
outsourcing. Conclusion:
This study highlights significant variation in genomic testing TATs for NSCLC across the East GMSA, with only one hospital meeting the 14-day benchmark through in-house testing funded at its own cost. Nine hospitals were able to complete end-to-end genomic testing within 28 days[1,3]. Testing at diagnosis, minimising transport delays, and eliminating duplication are key levers to reduce delays. Standardisation of pre-analytical processes and regional or national monitoring of pathways are essential to align performance with national expectations. With hospitals expected to deliver diagnostics and treatments against NHS cancer waiting times standards, patients requiring genomic testing risk longer waits based on local inequities. References: 1.NICE. Lung cancer: diagnosis and management.
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