S816
Clinical - Lung
ESTRO 2026
Angela Davey 1 , Ashley Horne 1,2 , Tom Marchant 3 , Alan McWilliam 1 , Marcel van Herk 1 , Corinne Faivre-Finn 1,2 , Gareth Price 1 , Azadeh Abravan 4,1 1 Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom. 2 Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom. 3 Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, United Kingdom. 4 Edinburgh Cancer Informatics, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom Purpose/Objective: Dose to the heart base has been associated with poor overall survival in lung cancer radiotherapy, motivating a cardiac-avoidance study. However, baseline comorbidities and cardiovascular medications may confound the relationship between cardiac dose and post-radiotherapy cardiovascular events.We conducted a matched-cohort analysis to quantify the baseline risk of diabetes for cardiovascular events. In a secondary, exploratory analysis, we evaluated cardiac dose and explored its interaction with comorbidities and medication to inform considerations for cardiac dose-response studies. Material/Methods: We retrospectively analysed 396 patients treated with radiotherapy for lung cancer between 2019-2023 (199 with diabetes, 197 without), population-matched on age, sex, and baseline cardiovascular status. Multivariable logistic regression predicted cardiovascular events (CTCAE) >6 months post- radiotherapy including age, sex, baseline cardiovascular status, diabetes, tumour stage and location, nodal stage, and smoking.On planning CT, the heart and cardiac avoidance region (aortic valve, proximal segments of right/ left coronary artery (R/LCA), right atrium) were automatically segmented and reviewed. Mean doses were analysed with multivariable logistic regression and bootstrapping (1000 resamples) reporting Akaike Information Criterion in overall and stratified cohorts. Interaction between cardiac dose, cardiovascular status, and diabetes medication (metformin) was investigated. Results: Smoking history differed across diabetes groups (Figure 1A). Baseline cardiovascular conditions were present in 64%. Cardiovascular events post- radiotherapy occurred in 25% of diabetes patients (49/199), and 15% of matched patients (29/197). Diabetes (p=0.015) and baseline cardiovascular status (p=0.01) were the only significant predictors (Figure 1B).
standard of care for patients with resectable, locally advanced NSCLC. However, a significant proportion of patients do not proceed to surgery after induction due to disease progression, medical ineligibility, or patient preference. In these cases, radiochemotherapy, often coupled with immune checkpoint inhibitors, represents a clinically meaningful alternative. This study evaluates the safety profile and clinical outcomes of radiotherapy (RT) combined with immune checkpoint inhibitors (ICI) in stage III–IV NSCLC, providing real-world survival estimates stratified by disease stage Material/Methods: Twenty-eight consecutive patients with stage III–IV NSCLC received RT in association with ICI between 2021 and 2024; 22 patients had completed follow-up and were therefore evaluable. RT was delivered with curative intent in stage III and consolidative or palliative intent in stage IV. Side effects were graded using CTCAE v5.0. Overall survival (OS) and progression-free survival (PFS) were assessed from the start of systemic therapy. Median follow-up was 20.3
months. Results:
RT combined with ICI showed an overall acceptable profile of adverse events. Low-grade side effects were the most frequent, including pneumonitis or radiation pneumonitis in 32% of patients, fibrosis in 42.8%, anemia in 13.6%, and dermatitis in 4.5%. A single grade-5 adverse event (MACE) occurred, together with isolated higher-grade side effects such as diarrhea, hypophysitis, and atelectasis. After a median follow-up of 20.3 months, median OS and PFS across the 22 evaluable patients were 20.3 and 18.4 months. Twelve- and 24-month OS rates were 95.2% and 71.2%, while PFS rates were 85.0% and 55.8%. Stage III patients achieved longer OS and PFS than stage IV patients, with sustained control over time. Conclusion: RT combined with ICI represents a feasible treatment pathway for patients who do not undergo surgery after induction chemo-immunotherapy, as well as for advanced-stage disease. Despite one grade-5 adverse event, the overall pattern of side effects was manageable, and both OS and PFS outcomes were encouraging. These findings support further investigation to refine treatment sequencing and optimize RT integration. Keywords: NSCLC, Immunoradiotherapy, chemoradiation
Digital Poster 3493
Unravelling the interplay of diabetes, medication, and cardiac dose for predicting cardiovascular events after lung cancer radiotherapy.
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