S819
Clinical - Lung
ESTRO 2026
pooled phase II. Radiother Oncol. 2024;190:109355. doi:10.1016/j.radonc.2023.109355 Keywords: NSCLC, immunotherapy, hypo-RT
Digital Poster Highlight 3517 Efficacy and safety of radical thoracic re- irradiation in patients with lung malignancies Marco Galaverni 1 , Federico Colombo 1 , Cristina Dell'Anna 1 , Elisabetta Lattanzi 1 , Claudia Grondelli 1 , Francesco Salaroli 1 , Ilaria Renna 1 , Maria Luisa Bergamini 1 , Giovanni Ceccon 1 , Stella Gianni 1 , Maria Majori 2 , Nicola Sverzellati 3 , Marcello Tiseo 4 , Nunziata D'Abbiero 1 , Nicola Simoni 1 1 Department of Radiation Oncology and Radiosurgery, University Hospital of Parma, Parma, Italy. 2 Pulmonology and Thoracic Endoscopy Unit, University Hospital of Parma, Parma, Italy. 3 Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy. 4 Medical Oncology Unit, University Hospital of Parma, Parma, Italy Purpose/Objective: Radical thoracic re-irradiation (re-TRT) is increasingly being used to treat lung malignancies in patients who previously received curative thoracic radiotherapy. Aim of this study was to investigate the efficacy and safety of re-TRT in lung malignancies. Material/Methods: Patients treated at our Institution with radical re-TRT ( ≥ 40 Gy EQD2) from 2018 to 2024 were retrospectively analyzed. All patients received VMAT with Simultaneous Integrated Boost (SIB). According to the ESTRO-EORTC criteria, re-TRT was classified as type 1 (overlap of irradiated volumes), type 2 (non- overlapping volumes but concern for adverse events from cumulative doses) or type 3 (repeat organ irradiation). Local progression-free survival (LPFS) and overall survival (OS) were estimated using Kaplan- Meier method. Adverse events following re-TRT were graded per CTCAE. Results: A total of 79 patients were included. Patients and treatment characteristics are shown in Table 1. Patients were treated with a first course of re-TRT (re- TRT1) for a new primary lung tumor, a loco-regional recurrence or an oligometastatic lesion in 25.3%, 24.1% and 50.6% of cases, respectively. Re-TRT1 was classified as type 1, 2 and 3 in 39 (49.4%), 22 (27.8%) and 18 (22.8%) patients, respectively.
At a median estimated follow-up time of 22.3 months (95% CI 20.3-35.7), the re-TRT1 local control rate (LCR) was 88.6%, with a 1-, 2 and 3-year LPFS rate of 90.6% (95% CI 83.7-98.1), 88.5% (95% CI 80.7-97.0) and 83.3% (95% CI 71.7-96.8), respectively. Twenty-two (27.8%) and 4 (5.1%) patients receiving a second (re-TRT2) and a third (re-TRT3) course of re-TRT, respectively. The re- TRT2 and re-TRT3 crude LCR was 95.5% and 100%, respectively. Median OS from re-TRT1 and from the last patient’s re-TRT course was 29.0 months (95% CI 13.9-44.0) and 20.3 months (95% CI 13.5-27.1), respectively (Figure 1). Cumulative incidence of G ≥ 3 adverse events was 8.9%, with G4 and possibly G5 pneumonitis in one and two cases respectively (all after type 1 re-TRT1). Patient with G4 pneumonitis had a mean lung cumulative EQD2 (EQD2cum, α / β 3) of 20.7 Gy. Patients with G5 pneumonitis had mean lung EQD2cum of 10.5 Gy and 4.8 Gy, respectively. The two cases of fatal pneumonitis were considered possibly related to re-TRT, since drug-related pneumonitis was also present in both cases.
Conclusion: Our analysis indicates that re-TRT is a safe and effective treatment option for this high-risk clinical scenario. Even in the context of multiple courses, re-
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