S785
Clinical - Lung
ESTRO 2026
Oncology, Amsterdam University Medical Centers, Amsterdam, Netherlands
Purpose/Objective: Patients with interstitial lung disease (ILD) are at increased risk for developing non-small cell lung cancer (NSCLC), as well as adverse events from treatment. There are limited data to guide treatment in patients with locally advanced (LA) NSCLC. The aim of this study is to systematically review outcomes and adverse events associated with definitive conventionally fractionated radiotherapy (RT) in patients with concurrent ILD and LA-NSCLC. Material/Methods: This systematic review was registered in PROSPERO and conducted in accordance with PRISMA guidelines. MEDLINE, EMBASE, and Cochrane Library databases were searched from inception until October 2025. Studies including patients undergoing definitive conventionally fractionated RT with or without chemotherapy were included. Data including treatment-related adverse events and overall survival (OS) were collected and analyzed. Results: Of 6821 records reviewed, 16 retrospective studies including 522 patients were eligible. Fifteen studies were conducted in East Asia and one in Australia. All studies utilized conventionally fractionated or moderately hypofractionated photon RT with daily doses of 1.8-3.0 Gy/fraction. Prescribed doses in EQD2 ranged from 40-70 Gy. All studies included patients receiving concurrent chemoradiotherapy, while 6 studies also included sequential chemoradiotherapy. Four of 12 studies published since 2017 directly addressed immunotherapy, with a minority of patients receiving consolidative durvalumab (n = 32, 6%). The most common reported subtypes were subclinical interstitial lung abnormalities (n = 260, 50%) and usual interstitial pneumonia (n = 56, 11%), with the specific ILD subtype not reported in 29% of patients (n = 153). Ten studies (62%) did not provide details of pulmonary function tests. One study reported the use of anti- fibrotic agents. By weighted proportion, the rate of grade 2-5 treatment-related respiratory adverse events was 39%, while the rate of treatment-related mortality was 12%. The most reported risk factor for adverse events was a higher volume of lung received at least 20 Gy (V20). OS at 1-, 2-, and 3-years ranged from 42-58%, 27-57%, and 11%, respectively. Conclusion: This systematic review provides objective summary data showing high rates of treatment-related adverse events and mortality in patients with LA-NSCLC and coexisting ILD who undergo definitive RT-based therapy, despite 50% of included patients having only subclinical ILD. As these patients are typically excluded from clinical trials, prospective data would improve
Conclusion: This single centre study revealed increasing age, treatment volume and performance status predicted poorer survival outcomes in lung cancer patients treated with SABR. Interestingly, a reduced pretreatment DLCO also predicted poorer overall survival. This is in line with other published studies.1,2 References: 1. Guckenberger, M et al. Is there a lower limit of pretreatment pulmonary function for safe and effective stereotactic body radiotherapy for early-stage non-small cell lung cancer? Journal of thoracic oncology. 2012 Mar;7(3):542-512. Kang, J. et al. Predicting 5-Year Progression and Survival Outcomes for Early Stage Non-small Cell Lung Cancer Treated with Stereotactic Ablative Radiation Therapy: Development and Validation of Robust Prognostic Nomograms. International Journal of Radiation Oncology*Biology*Physics 106, 90–99 (2020). Keywords: SABR, prognostic factors, retrospective Outcomes following radiotherapy for patients with locally advanced non-small cell lung cancer and interstitial lung disease – a systematic review George J Li 1 , Melissa Sam Soon 1 , Michael C Tjong 1 , Gabriel Boldt 2 , Houda Bahig 3 , Patrick Cheung 1 , David A Palma 2 , Christopher J Ryerson 4 , Shankar Siva 5 , Suresh Senan 6 , Alexander V Louie 1 1 Department of Radiation Oncology, University of Toronto, Toronto, Canada. 2 Department of Radiation Oncology, London Health Sciences Centre, London, Canada. 3 Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada. 4 Department of Medicine, University of British Columbia, Vancouver, Canada. 5 Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia. 6 Department of Radiation Digital Poster Highlight 2293
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