S795
Clinical - Lung
ESTRO 2026
References: 1. McNamara ME, Loyfer N, Kiliti AJ, et al. Circulating cell-free methylated DNA reveals tissue-specific, cellular damage from radiation treatment. JCI Insight. 07/24/ 2023;8(14)doi:10.1172/jci.insight.1565292. Zemmour H, Planer D, Magenheim J, et al. Non- invasive detection of human cardiomyocyte death using methylation patterns of circulating DNA. Nature Communications. 2018/04/24 2018;9(1):1443. doi:10.1038/s41467-018-03961-y3. Loyfer N, Magenheim J, Peretz A, et al. A DNA methylation atlas of normal human cell types. Nature. 2023/01/01 2023;613(7943):355-364. doi:10.1038/s41586-022- 05580-6 Keywords: cfDNA, biomarker, cardiac adverse events Lower BED SBRT in Frail Patients with Recurrent Lung-Only Metastases: Comparable Control, Reduced Toxicity Ismaell Massalha 1,2 , Mhammad Abu Juda 2 , Reem Zabit 2 , Nitzan Sagie 2 , Kim Sheva 2 , Leonid Bogomolni 2 , Olga Belochitski 2 , Adham Hijab 1 , Yonina Tova 1 , Amichay Meirovitz 2 , Konstantin Lavrenkov 2 1 Radiation oncology, Rivka Ziv Medical Center, Tzfat, Israel. 2 The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center, Beer Sheva, Israel Purpose/Objective: Stereotactic body radiation therapy (SBRT) is widely used for recurrent lung metastases, with a biologically effective dose (BED) of ≥ 100 Gy typically Digital Poster 2580 recommended to optimize local control. However, delivering high-dose SBRT can be challenging in frail patients or those with ultracentral tumors, where the risk of severe toxicity may outweigh potential benefits. Despite emerging interest in dose de-escalation, robust evidence for BED <100 Gy in these high-risk settings remains limited. This study evaluates the feasibility and clinical outcomes of reduced BED in patients with recurrent lung-only metastases. Material/Methods: We conducted a retrospective analysis of 53 consecutive patients with recurrent lung-only metastases treated with SBRT from 2019 to 2022. Clinical data, including demographics, tumor characteristics, BED, and follow-up outcomes, were collected. Primary endpoints included overall survival (OS), progression-free survival (PFS), and freedom from local-regional progression (FFLP). Subgroup analyses compared outcomes between patients treated with BED <100 Gy and those receiving ≥ 100 Gy. Results: The cohort included 53 patients (64% male; mean age
Conclusion: cfDNA methylation profiling enables tissue-specific assessment of cardiac injury and provides temporal insight into mechanisms of CRT-related cardiac toxicity, highlighting vascular injury, immune activation, and mitochondrial and structural remodeling as key drivers of cardiac dysfunction.
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