S817
Clinical - Lung
ESTRO 2026
interaction contributing to a mean improved model performance. In patients without baseline cardiovascular conditions, risk increased with mean heart dose and was higher in metformin users, whereas in patients with baseline cardiovascular conditions, metformin appeared protective at higher heart doses (Figure 2B). Conclusion: Diabetes increases post-radiotherapy cardiovascular risk, and cardiac substructure doses may impact sub- populations differently, which is detectable with matched-cohort methods that highlight other patient factors. Interactions with baseline cardiovascular status and metformin highlights the importance of including patient-specific factors in cardiac dose- response studies. Limitations include cohort size and constrained variation due to matching, limiting generalisability. Understanding of these findings may be improved using causal approaches to further optimise cardiac-sparing strategies for lung cancer radiotherapy. Keywords: cardiovascular events, diabetes, heart dose Proffered Paper 3506 Updated clinical outcomes and cytokine analysis from the Re-induction trial (NCT03406468): hypofractionated RT plus immunotherapy in metastatic NSCLC Valentina Bartolomeo 1,2 , Lizza E.L. Hendriks 3 , Juliette Degens 4 , Lotte Wieten 5 , Stephanie Peeters 2 , Rianne D.W. Vaesb 2 , Ruud Houben 2 , Andrea Riccardo Filippi 6,1 , Dirk K.M. de Ruysscher 2 1 Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 2 Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Center, GROW – Research Institute for Oncology and Reproduction, Maastricht, Netherlands. 3 Department of Pulmonary Diseases, GROW – Research Institute for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, Netherlands. 4 Department of Pulmonary Diseases,, Zuyderland Hospital, Heerlen, Netherlands. 5 Department of Transplantation Immunology, GROW School for Oncology and Reproduction. Maastricht University Medical Center, Maastricht, Maastricht, Netherlands. 6 Department of Oncology, University of Milan, Milan, Italy Purpose/Objective: Immune checkpoint inhibitors (ICIs) alone or with chemotherapy, have become standard of care for patients with metastatic non-small cell lung cancer (NSCLC)1. However, most patients do not obtain long- term benefit2. Preclinically, hypofractionated radiotherapy (hypo-RT) may stimulate the immune
Imaging was available for 74% (152 diabetes, 140 non- diabetes) preserving matching. Cardiac doses variable did not improve AIC, but stratified analysis suggests substructure doses (i.e., RCA dose) may be predictive in subgroups (Figure 2A).
Metformin was prescribed in 75% of patients with diabetes. Bootstrapping highlighted a potential
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