S776
Clinical - Lung
ESTRO 2026
ischemia. Moreover, there was no increase in troponin-T levels as a marker of myocardial damage, and no increase of the heart failure marker NT- proBNP. Echocardiography did not show signs of declined left ventricular systolic function (fig.1b). However, there was a statistically significant increase in the E/e' ratio (fig.1c). Pulmonary function decline was mild (fig.2b-c).
immunomodulation, NSCLC
Digital Poster Highlight 1831 Dose-escalated stereotactic MR-guided adaptive RT
for ultracentral lung tumors: First-year cardiopulmonary data of the prospective MAGELLAN trial
Markus Ehle 1 , Lukas Bauer 1 , Rasmus Schindehütte 1 , Tobias M. Barton 1 , Efthimios Katsigiannopulos 1 , Fabian Weykamp 1 , Maximilian Y. Deng 1 , Thomas Welzel 1 , Nicolaus Andratschke 2 , Matthias Guckenberger 2 , Lorenz Lehmann 3 , Jürgen Debus 1 , Juliane Hörner- Rieber 4 , Sebastian Regnery 1 1 Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany. 2 Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland. 3 Department of Cardiology, Section for Cardio Oncology, University Hospital Heidelberg, Heidelberg, Germany. 4 Department of Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany Purpose/Objective: SBRT allows ablation of inoperable primary and secondary lung tumors but it carries an increased risk of high-grade side effects when treating ultra-centrally located lung tumors (ULT). With MRI-guided SBRT (MRgSBRT), dose escalation while sparing risk organs may be possible. The MAGELLAN trial is a prospective, multicenter phase I dose escalation trial to investigate the safety of MRgSBRT for ULT. Here, we analyze the pre-specified secondary cardiopulmonary endpoints. Material/Methods: Between 01/2022 and 03/2025, 33 patients with indication for SBRT of an ULT (<5cm) were included. ULT were defined as contact of the PTV with esophagus or proximal bronchial tree (PBT). SBRT dose was escalated in four dose levels (10x5.0–6.5Gy) based on a continual reassessment method with time- to-event modification (TITE-CRM). Treatment was delivered using a 0.35T MR-linac with daily online plan adaptation and gated delivery. Patients underwent structured clinical follow-up every three months and cardiology assessments were performed before and one year post-SBRT. Results: Eight, twelve, six, and three patients received a total dose of 50Gy, 55Gy, 60Gy, and 65Gy, respectively. Eight patients received maximum heart doses above 55Gy (fig.1a), exceeding current dose constraints [1]. Two patients received cardiotoxic systemic therapy (trastuzumab/doxorubicin) during the follow-up interval. There were no cardiac adverse events. ECGs before and 12 months after radiation therapy demonstrated no new arrhythmias or signs of
Conclusion: Currently, the relationship between SBRT dose and cardiac toxicity remains poorly understood. Our data
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