S787
Clinical - Lung
ESTRO 2026
Francesco Verderame 5 , Francesco Azzarello 6 , Giuseppe Carruba 2 , Giuseppe Ferrera 1 1 Radiation Oncology, ARNAS Civico Hospital, Palermo, Italy. 2 Clinical Research, ARNAS Civico Hospital, Palermo, Italy. 3 Clinical Research, Kore University, Enna, Italy. 4 Medical Oncology, ARNAS Civico Hospital, Palermo, Italy. 5 Medical Oncology, Villa Sofia - Cervello Hospital, Palermo, Italy. 6 Medical Physics, ARNAS Civico Hospital, Palermo, Italy Purpose/Objective: For patients with unresectable stage III non–small-cell lung cancer (NSCLC) who are ineligible for concurrent chemo-radiation, stereotactic radiotherapy (SBRT) may provide a favorable efficacy–toxicity balance. Material/Methods: STARLORD is a prospective mono-institutional phase II study evaluating safety, tolerability, and early outcomes of SBRT after chemotherapy for locally- advanced NSCLC. The primary endpoint was acute G ≥ 3 cardiopulmonary toxicity assessed using CTCAE v5.0. Secondary endpoints included local control (LC), distant progression–free survival (DPFS), overall survival (OS), late toxicity. Time-to-event analyses were complemented by penalized Cox (ridge) models. Results: From March 2024 26 consecutive patients with locally- advanced NSCLC with median age 75 years (range, 68- 83 years) were enrolled; 84.6% of cases were stage IIIB, 15.4% IIIC at initial staging; ECOG PS=2 was observed in 57.7% of cases.Adenocarcinoma and squamous cell equally accounted for 84.6% of all primary histologies; the remaining were large-cell neuroendocrine tumors. All patients received sequential chemotherapy plus SBRT for primary and mediastinal disease for a median total dose of 40 Gy (40-50 Gy) and 35 Gy (35-40 Gy) respectively, delivered in 5 fractions with Radixact system. Six patients were PD-L1 negative, no patient was oncogene-addicted. Maintenance durvalumab after sequential chemo- radiation was administered in 76.9% of patients.Median follow-up was 18.2 months (95% CI 17.3–not reached). All patients completed chemo- radiation without interruptions. Acute toxicity was limited: G3 and G2 dysphagia were observed respectively in 7.7% and 15.3% of cases: no acute G ≥ 4 or late G ≥ 3 events were observed. For late events, only 5 G2 events were reported, consisting of 2 dysphagia cases and 3 dyspnea temporary worsening, all fully resolved with oral steroids. 1-year LC rate was 92.3%, with 2 cases of in-field mediastinal progression occurring 11 and 12 months after SBRT.Median DPFS was 15.6 months (95% CI 11.0–NR) with 1- and 2-years rates of 88.5% and 60.9%. In multivariable analysis, late toxicity was related to lower DPFS rates (HR 2.29; p=0.018), whereas higher total RT dose was associated with improved DPFS (HR 0.85 per Gy; p=0.044). Four
adverse events occurred: one sudden death (unrelated) and one fatal hemoptysis (related). The latter followed palliative type 1 reirradiation 14 months after central SBRT, with hemoptysis occurring 8 months later. No grade 4 adverse events were observed. Twelve patients (12.2%) experienced grade 3 infection (Table 2). The most other frequent ≥ 3 toxicities were dyspnea (12.2%) and fatigue (10%). Lower-grade events were common but mild and manageable. No unexpected late toxicities have been observed to date.
Conclusion: SBRT for centrally located lung tumors in the STRICT Lung trial demonstrated a very low incidence of severe (grade 4–5) toxicity, with acceptable overall toxicity and only one treatment-related fatal event in a patient who received palliative re-irradiation at the same site. These interim results support the safety and feasibility of SBRT for central lung lesions when delivered according to strict, protocol-defined dose constraints. References: 1. K Lindberg, V Grozman, K Karlsson, et al. The HILUS- trial - A prospective nordic multicenter phase 2 study of ultracentral lung tumors treated with stereotactic body radiotherapy J Thorac Oncol, 16 (2021), pp. 1200- 1210.2. L Hoffmann, GF Persson, L Nygard, et al. Thorough design and pre-trial quality assurance (QA) decrease dosimetric impact of delineation and dose planning variability in the STRICTLUNG and STARLUNG trials for stereotactic body radiotherapy (SBRT) of central and ultra-central lung tumours. Radiother Oncol, 171 (2022), pp. 53-61. Keywords: Centrally located lung tumors, SBRT
Mini-Oral 2305
STereotActic Radiotherapy in LOcally advanced non-small cell lung cancer unfit for concurRent chemoraDiation:preliminary results of the STARLORD study Francesco Cuccia 1 , Marina Campione 2,3 , Gianluca Mortellaro 1 , Salvatore D'Alessandro 1 , Giuseppa Savio 4 , Agata Laudani 4 , Livio Blasi 4 , Francesca Spinnato 5 ,
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