S761
Clinical - Lung
ESTRO 2026
1 Radiation Oncology, University Medical Center Groningen, Groningen, Netherlands. 2 Cardiology, Radboud University Medical Center, Nijmegen, Netherlands. 3 Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands. 4 Radiology, University Medical Center Groningen, Groningen, Netherlands. 5 Cardiology, University Medical Center Groningen, Groningen, Netherlands Purpose/Objective: With improving survival, cardiac side effects become more important in thoracic cancer. Echocardiography enables non-invasive early detection of cardiac dysfunction, allowing timely intervention. However, individual factors such as cardiovascular comorbidities and sex may modulate cardiac responses to chemoradiotherapy (CRT). Understanding these individual response patterns may guide personalized care. Therefore, this study aimed to (1) identify patterns of echocardiographic changes following CRT, and (2) assess their association with cardiovascular risk factors and sex. Material/Methods: We analysed 210 lung and oesophageal cancer patients receiving photon/proton CRT at UMCG and RadboudUMC as part of the CLARIFY study (NCT03978377). Echocardiography was performed at baseline and at 6-52 weeks post-treatment. Cardiac ultrasound patterns were identified using multilevel principal component analysis. Associations between principal component (PC) scores and clinical factors, including age, sex, comorbidity, diabetes, and antihypertensive use, were assessed via mixed-effects
biological effective dose (BED) than CRT in CHISEL (84Gy vs 62.5-79.2Gy), which might also be an important reason for the observed OS discrepancy.Figure 1. Forest Plot showing OS (CHISEL and LUSTRE trial)
Figure 2. Comparison of CHISEL vs LUSTRE CRT arms
Conclusion: Our analysis showed that the conflicting OS results between SABR versus CRT trials could be due to different CRT arm effects, with SABR demonstrating consistent efficacy. The improved survival in the CRT arm in LUSTRE compared to CHISEL emphasised that trial outcomes can be heavily affected by differences in baseline patient characteristics and CRT protocols. References: Ball D, Mai GT, Vinod S, et al. Stereotactic ablative RT versus standard RT in stage 1 non-small-cell lung cancer (TROG 09.02 CHISEL): a phase 3, open-label,
models. Results:
randomised controlled trial. Lancet Oncol. 2019;20(4):494-503. doi:10.1016/S1470-
Among the 210 patients (median age 65; 46% lung cancer, 54% oesophageal cancer; 31% female; 23% with cardiovascular comorbidity), four cardiac function patterns explained 33% of variance (Figure 1). Figure 1. Identified cardiac ultrasound patterns
2045(18)30896-9Nyman J, Hallqvist A, Lund JÅ, et al. SPACE - A randomized study of SBRT vs conventional fractionated RT in medically inoperable stage I NSCLC. Radiother Oncol. 2016;121(1):1-8. doi:10.1016/j.radonc.2016.08.015Swaminath A, Parpia S, Wierzbicki M, et al. Stereotactic vs Hypofractionated RT for Inoperable Stage I Non-Small Cell Lung Cancer: The LUSTRE Phase 3 Randomized Clinical Trial. JAMA Oncol. 2024;10(11):1571-1575. doi:10.1001/jamaoncol.2024.3089 Keywords: Stereotactic Ablative Radiotherapy, NSCLC Digital Poster Highlight 686 Identifying cardiac risk profiles to personalize chemoradiotherapy in thoracic cancer Arno C. Hessels 1 , Umut Fidan 1 , Robin Wijsman 1 , Anthonie L. Duijnhouwer 2 , Jan Bussink 3 , Tineke P. Willems 4 , Elke S. Hoendermis 5 , Joost van Melle 5 , Peter van der Meer 5 , Johannes A. Langendijk 1 , Christina T. Muijs 1 , Peter van Luijk 1
PC1 increased post-treatment, peaking at 12 weeks (P<0.001), indicating reduced right atrial pressure. At baseline, right atrial pressure was higher for older patients (P=0.04) and those with oesophageal cancer (P<0.001).PC2 declined to its nadir at 52 weeks
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