S768
Clinical - Lung
ESTRO 2026
833. doi:10.1136/thoraxjnl-2021-218577 Keywords: NSCLC, IPF, Prognostic Signature
(Figure 2).
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Cardiac Toxicity in Patients with Central and Ultracentral Lung Tumors Treated with SBRT: A Multicentric Study Axel Licha 1 , Felix Felici 1 , Leila Bouazzi 2 , Coralie Barbe 2 , Antoine Cordier 1 , Loig Duverge 3 , Amelie Lemoine 4 , Elvire Martin-Mervoyer 5 , Alexandra Moignier 6 , François Thillays 6 , Loig Vaugier 6 , Arnaud Beddok 1 1 Department of Radiation Oncology, Institut Jean Godinot, Reims, France. 2 2. Research on Health
University Department, University of Reims Champagne-Ardenne, Reims, France. 3 3.
Department of Radiation Oncology, Centre Eugène Marquis, Rennes, France. 4 4. Department of Medical Oncology, Institut Jean Godinot, Reims, France. 5 5. Department of Cardiology, Institut de Cancérologie de l’Ouest, Saint-Herblain, France. 6 6. Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Saint-Herblain, France Purpose/Objective: Central and ultracentral lung tumors frequently abut the heart, great vessels, or the proximal bronchial tree, exposing patients to an elevated risk of late cardiotoxicity. While SBRT is considered standard for medically inoperable stage I NSCLC and selected oligometastatic disease, data regarding cardiac outcomes in central and ultracentral anatomical locations remain limited. This multicenter study aimed to determine the prevalence, timing, and clinical predictors of symptomatic cardiac toxicity after SBRT delivered with contemporary risk-adapted regimens. Material/Methods: A retrospective cohort of 194 adults treated with SBRT for central or ultracentral lung nodules was assembled across three French cancer centers (March 2016- March 2023). Centrality definitions followed SUNSET and RTOG 0813 criteria. Patients with <6 months of follow-up were excluded from toxicity analyses, yielding 162 evaluable cases. Cardiac events were graded using CTCAE v5.0. Time to toxicity was calculated from a six-month post-SBRT landmark to minimize attribution bias. Variables associated with toxicity at p < 0.10 in univariable analysis entered a Firth-penalized multivariable logistic regression. Overall survival (OS) was assessed using Kaplan-Meier and Firth-corrected Cox models. Local and distant relapses were estimated as competing risks. Results: Grade ≥ 2 cardiac events occurred in 13/162 patients (8.0%; 95% CI, 3.8-12.2), with a median onset of 12.6 months after SBRT (IQR 7.9-19.6). The most common
Conclusion: We report for the first time that a validated 22-gene IPF-associated signature is independently prognostic for OS in NSCLC. Our results could inform future genotype–phenotype (imaging) studies and support the evaluation of this signature for predicting treatment-related morbidity and mortality in NSCLC patients with coexistent IPF. References: [1] Tzouvelekis A, Spagnolo P, Bonella F, et al. Patients with IPF and lung cancer: diagnosis and management. Lancet Respir Med. 2018;6(2):86-88. doi:10.1016/S2213-2600(17)30478-2[2] Allen RJ, Guillen-Guio B, Oldham JM, et al. Genome-Wide Association Study of Susceptibility to Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med. 2020;201(5):564-574. doi:10.1164/rccm.201905- 1017OC[3] Allen RJ, Stockwell A, Oldham JM, et al. Genome-wide association study across five cohorts identifies five novel loci associated with idiopathic pulmonary fibrosis. Thorax. 2022;77(8):829-
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