S759
Clinical - Lung
ESTRO 2026
is robust across real-world and propensity-matched cohorts, underscoring the clinical rationale for incorporating TRT into multimodality management. Ongoing randomized trials (NRG-LU007, TREASURE, RAPTOR) are expected to define optimal timing, dose, and patient selection to maximize benefit. References: 1. Yao et al- Radiat Oncol19, 25 (2024). https://doi.org/10.1186/s13014-024-02420-x2. Cai et al- Transl Lung Cancer Res. 2023 Oct 31;12(10):1987- 2000. doi: 10.21037/tlcr-23-294.3. Zheng et al- Ann Transl Med. 2023 Jan 31;11(2):60. doi: 10.21037/atm- 22-5853.4. Huang et al. Respiratory Research (2025) 26:85 https://doi.org/10.1186/s12931-025-03157-15. caks et al. Int. J. Mol. Sci. 2025, 26, 3631. https://doi.org/ 10.3390/ijms260836316. Mu et al. Cancer Med. 2024;13:e70175. doi:10.1002/cam4.701757. Monaca et al. Eur J Cancer. 2025 Jul 25;225:115592. doi: 10.1016/j.ejca.2025.115592.8. Varlotto et al. Radiother Oncol. 2025 Jan;202:110619. doi: 10.1016/j.radonc.2024.110619.9. Zhang et al. 2025. doi: 10.1016/j.lungcan.2025.108758 Keywords: thoracic RT, small-cell lung cancer, immunotherapy Digital Poster 627 Safety and efficacy of stereotactic ablative radiotherapy in combination with Tarlatamab in patients with ES-SCLC: a case series. Giuseppina Apicella 1 , Donatella Caivano 1 , Sara Gomellini 1 , Antonio Lugini 2 , Leonardo Cristofani 2 , Serena Verna 2 , Antonella Stravato 3 , Anna Trezza 3 , Angelo Calabrese 4 , Daniela Musio 1 1 Radiation Oncology, San Giovanni Addolorata, Rome, Italy. 2 Medical Oncology, San Giovanni Addolorata, Rome, Italy. 3 Medical Physics, San Giovanni Addolorata, Rome, Italy. 4 Interventional pneumology, San Giovanni Addolorata, Rome, Italy Purpose/Objective: Stereotactic ablative radiotherapy (SABR) represents a milestone in the management of oligoprogressive disease during systemic therapy. The recent approval of Tarlatamab for second-line treatment of extensive- stage small-cell lung cancer (ES-SCLC) has opened new therapeutic perspectives. However, evidence regarding the safety and efficacy of combining Tarlatamab with radiotherapy is still limited. We report the outcomes of SABR delivered concurrently with Tarlatamab in three patients treated at our institution, illustrating the feasibility of integrating SABR with ongoing Tarlatamab therapy. Material/Methods: Three patients with ES-SCLC receiving Tarlatamab
Random-effects models were used to calculate pooled HRs with 95 % confidence intervals (CIs); heterogeneity was assessed using the I ² statistic. Results:
Twenty-four eligible studies (6,200 patients) were included: 5 prospective, 12 multi-centre retrospective, and 7 real-world analyses spanning Asia, Europe, and North America. Median follow-up ranged 8–32 months; most studies delivered TRT doses of 30–60 Gy. The pooled HR for OS = 0.61 (95 % CI 0.54–0.69; I ² = 10 %), indicating a 39 % reduction in mortality with TRT. The pooled HR for PFS = 0.66 (95 % CI 0.58–0.74; I ² = 6 %), confirming consistent improvement in disease control. Subgroup analyses indicated maximal benefit among patients with ≤ 2 metastatic sites, absence of liver involvement, and good systemic response, as well as consistent benefit across geographic regions, PD-L1 agents (durvalumab or atezolizumab), and disease burden categories. Median OS among TRT recipients ranged from 16 to 22 months compared with 10 to 14 months without TRT. Locoregional control improved markedly, with intra thoracic PFS gains of 3–6 months. Toxicity was manageable: grade ≥ 3 pneumonitis occurred in 5–10 % of patients, with very few immune- related discontinuations and no reported treatment- related mortality. Early or concurrent TRT was associated with improved thoracic control and comparable safety to delayed TRT. Conclusion: In the immunotherapy era, consolidative thoracic radiotherapy after first-line chemo-immunotherapy significantly improves overall and progression-free survival in ES-SCLC, with acceptable safety. The effect
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