S821
Clinical - Lung
ESTRO 2026
The clinical indications and safety of contralateral hilar irradiation in patients with positive contralateral hilar LNs remain unclear. Given the paucity of evidence, further well-designed studies are essential to clarify its feasibility and potential therapeutic benefit under current standards of care, which include IMRT-based chemoradiotherapy followed by ICIs. References: [1] Curran WJ Jr, Moldofsky PJ, Solin LJ. Analysis of the influence of elective nodal irradiation on postirradiation pulmonary function. Cancer. 1990;65(11):2488-93. PMID: 2159839[2] Valan CD, Slagsvold JE, Halvorsen TO, et al. Survival in Limited Disease Small Cell Lung Cancer According to N3 Lymph Node Involvement. Anticancer Res. 2018;38(2):871-876. PMID: 29374714[3] Kiricuta IC, Mueller G, Stiess J, et al. The lymphatic pathways of non-small cell lung cancer and their implication in curative irradiation treatment. Lung Cancer. 1994;11(1-2):71-82. PMID: 8081706 Keywords: lung carcinoma, radiotherapy, contralateral hilum Digital Poster 3628 Establishing a Credentialing Framework for Functional Lung-Sparing Radiotherapy Planning in the Phase III TROG 21.08 VITaL Clinical Trial Guneet Kaur 1,2 , Nicholas Hardcastle 3 , John Kipritidis 4 , Benjamin Zwan 5 , Anthony Espinoza 6 , Shalini K Vinod 6 , Cynleen Kai 7 , Douglas Hoover 8 , Logan Seddon 1 , Amy Murray 1 , Jessica Beech 5 , Kimiya Asgari 4 , Kylie Grimberg 4 , Vinh Luong-Poole 6 , Alisha Moore 9 , Olivia Cook 9 , Nina Eikelis 10 , Hilary Byrne 1,2 , Paul Kneall 2 1 Radiation Oncology, GenesisCare, Sydney, Australia. 2 Image X Institute, The University of Sydney, Sydney, Australia. 3 Radiation oncology, Peter MacCallum, Sydney, Australia. 4 Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia. 5 Radiation Oncology, Gosford Hospital, Gosford, Australia. 6 Radiation Oncology, Liverpool Hospital, Sydney, Australia. 7 Radiation Oncology, GenesisCare, Victoria, Australia. 8 Department of Oncology, Western University, London, Canada. 9 TROG Cancer Research, Trans-Tasman Radiation Oncology Group, Waratah, Australia. 10 Medical and Clinical Affairs, 4D Medical, Melbourne, Australia
and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Purpose/Objective: Management of patients with positive contralateral hilar lymph nodes (LNs) remains controversial. Clinical data on contralateral hilar irradiation using three- dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) are limited, and it is unclear whether definitive radiotherapy (RT) can be safely and effectively delivered for these patients. Consequently, treatment decisions are often made empirically, reflecting the lack of robust evidence to guide clinical practice. Therefore, we conducted a systematic review to evaluate the toxicity and efficacy of contralateral hilar irradiation in lung cancer. Material/Methods: A literature search was conducted in PubMed from the inception of the database through June 2025. Search terms included synonyms and related terms for “lung cancer,” “radiotherapy,” and “contralateral hilum.” We included articles in which radiotherapy was performed for the contralateral hilum or in which radiological assessments were conducted for contralateral hilar LN metastases. Exclusion criteria were case reports, publications not in English, and articles that did not provide sufficient details regarding inclusion criteria. The primary outcome was toxicities associated with contralateral hilar irradiation, and key secondary outcome was overall survival (OS). Results: Of 606 articles identified, 11 met the inclusion criteria: seven on non-small cell lung cancer (NSCLC) and four on small-cell lung cancer (SCLC). For the primary outcome, no direct toxic data, such as radiation pneumonitis associated with contralateral hilar irradiation, were available. One planning study [1] reported a reduction in FEV following contralateral hilar irradiation: median FEV was 2.0 L before RT and 1.0 L after. Regarding the key secondary outcome, two studies reported OS in patients with positive contralateral hilar LNs who received irradiation. One study using 3D-CRT [2] reported no clinically relevant differences in median survival among N3 subcategories of limited-disease SCLC, including contralateral hilar, contralateral mediastinal, and supraclavicular LNs: approx. 15 months. Another study using 3D-CRT [3] found no significant differences in survival curves between NSCLC patients with contralateral hilar LNs and those with supraclavicular LNs. Across these studies, no patients with contralateral hilar LNs survived beyond five years. No survival data were available for contralateral hilar irradiation using IMRT combined with consolidative immune checkpoint inhibitors (ICIs). Conclusion:
Purpose/Objective: The phase III TROG 21.08 VITaL clinical trial
(NCT06127654) investigates whether CT ventilation imaging-guided planning improves outcomes for lung cancer patients. To ensure high-quality and consistent treatment delivery across institutions, and to minimise bias between the two arms, a structured credentialing program for radiotherapy planning was developed to
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