S796
Clinical - Lung
ESTRO 2026
observed safety profile with reduced BED highlights the potential for dose adaptation in medically vulnerable populations. These findings underscore the need for prospective trials to better define optimal SBRT dosing strategies in frail patients. References: - Alite F, Mahadevan A. Dose escalation in the era of ablative lung irradiation: is more dose better when it comes to delivery of lung stereotactic body radiation therapy? Ann Transl Med. 2020 Oct ;8(20):1325–1325. Available from: /pmc/articles/PMC7661867/- Agolli L, et al. Lung Metastases Treated With Stereotactic Ablative Radiation Therapy in Oligometastatic Colorectal Cancer Patients: Outcomes and Prognostic Factors After Long-Term Follow-Up. Clin Colorectal Cancer [Internet]. 2017 Mar 1;16(1):58–64.- Sutera P, et al. Initial Results of a Multicenter Phase 2 Trial of Stereotactic Ablative Radiation Therapy for Oligometastatic Cancer. Int J Radiat Oncol Biol Phys [Internet]. 2019 Jan 1;103(1):116–22. Keywords: dose de-escalation, frailty, SBRT Lessons learned in SBRT practice for early-stage Non-Small cell Lung Cancer – Experience of a Tertiary Cancer Centre of India Jai Prakash Agarwal 1 , Anil Tibdewal 1 , Guncha Maheshwari 1 , Subramanya Adiga 1 , Simran Gulati 1 , Memtombi Ngasepam 1 , Ritesh Mhatre 2 , Yogesh Ghadi 2 , Gaurav Khatavkar 1 , Srilaxmi Pedapathi 1 , Shivani Yewle 1 1 Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India. 2 Department of Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India Purpose/Objective: Early-stage non-small cell lung cancer has an excellent prognosis, but less than 10-15% present in the early stage. Stereotactic body radiation therapy is the standard treatment for medically inoperable and Digital Poster 2586 unwilling for surgery in ES-NSCLC. In this retrospective analysis, we have highlighted the lessons learned and analysed the outcomes of SBRT for ES-NSCLC. Material/Methods: From 2008-2025, consecutive patients of ES-NSCLC treated with SBRT were included. Staging workup included F-18-FDG-PET-CT, MRI Brain, and PFT-DLCO. All patients deemed medically inoperable in MDT were treated with SBRT using conformal technique and motion management strategies. CECT Thorax every 3 months for first 2 years and every 6 months thereafter. The whole cohort was divided into 2 cohorts: patients treated from 2008 to 2015 (cohort A)
71) with a median follow-up of 40 months. Eighteen patients (34%) received SBRT with BED <100 Gy due to frailty, poor performance status (78% ECOG 3), or ultracentral tumor location. OS rates at 1-, 2-, and 3- years were 81%, 64%, and 56%; PFS rates were 60%, 41%, and 31%. No significant differences were observed between BED groups in OS (p=0.35), PFS (p=0.17), or FFLP (p=0.18). Local recurrence was rare (n=3), while grade 3 toxicity, including esophagitis and pneumonitis, was more frequent in the BED ≥ 100 Gy group.
Conclusion: This study suggests that SBRT with BED <100 Gy may offer clinically acceptable local control and survival outcomes in frail patients with recurrent lung-only metastases, where higher doses may pose significant toxicity risks. Although the study's retrospective nature and modest cohort size limit definitive conclusions, the
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