S840
Clinical - Lung
ESTRO 2026
University of Toronto, Toronto, Canada. 6 Department of Otolaryngology—Head & Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada Purpose/Objective: Airway obstruction and hemorrhage from thoracic tumors carry high morbidity and mortality. In many cases, interventions, including urgent palliative radiotherapy (RT), are initiated only after a catastrophic event has occurred. However, the outcomes of RT administered under such circumstances remain poorly understood. We evaluated overall survival (OS) following RT for catastrophic versus non-catastrophic airway events and identified prognostic factors influencing outcomes. Material/Methods: This retrospective cohort study included consecutive adult patients who received palliative thoracic RT at a tertiary cancer center between January 2015 and June 2023, with chest CT imaging available within three months prior to treatment. Catastrophic events were defined as airway compromise of grade ≥ III per CTCAE version 5 or those requiring urgent intervention, whereas grade I–II events are considered non- catastrophic. Clinical and demographic parameters, including age at radiotherapy, sex, survival, cancer primary site, stage, radiation dose and fractionation, and treatment indication (non-airway related, non- catastrophic airway, or catastrophic airway event) were extracted from the electronic health record. The primary outcome of the study was OS, measured from RT to death or last follow-up using the Kaplan–Meier method. Univariable and multivariable Cox regression analyses were used to assess the association between clinical and demographic variables and OS. Results: Among 281 patients who met inclusion criteria, 73 (26.0%) received RT for catastrophic airway events, 64 (22.8%) for non-catastrophic events, and 144 (51.2%) for non-airway indications (e.g., spinal nerve compression, thoracic bone metastases). The most common RT regimens were 20 Gray (Gy) in 5 fractions (68.3%) and 30 Gy in 10 fractions (14.6%), with 30 Gy in 10 fractions being less common in patients after catastrophic events (p<0.05). Median OS was 194 days (95% CI: 165-232, IQR: 82-461). Patients with catastrophic events had significantly shorter median OS (118 days, 95% CI: 84-181, IQR: 59-336) compared with non-catastrophic events (249 days, 95% CI: 196– 308, IQR: 121-524) and non-airway indications (214 days, 95% CI: 176-278, IQR: 97-541) (p<0.05). 40.6% of patients with catastrophic events died within 90 days of radiotherapy. On multivariable analyses, catastrophic events remained associated with worse OS versus non-catastrophic events (HR 1.61, 95% CI
1.09–2.37).
Conclusion: Patients requiring RT for catastrophic airway events have unfavorable long-term OS, reflecting advanced disease and limited opportunity for long-term benefit at this stage. Earlier recognition and intervention for airway compromise may improve outcomes. These findings support the need for developing predictive tools for impending airway events and to prospectively evaluate multimodality prevention strategies. References: 1. Johnson AG, Soike MH, Farris MK, Hughes RT. Efficacy and Survival after Palliative Radiotherapy for Malignant Pulmonary Obstruction. J Palliat Med. 2022;25(1):46-53. doi:10.1089/jpm.2021.01992. Choi HS, Jeong BK, Jeong H, Ha IB, Kang KM. Role of radiotherapy in the management of malignant airway obstruction. Thorac Cancer. 2020;11(8):2163-2169.3. Rodrigues G, Videtic GMM, Sur R, et al. Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline. Pract Radiat Oncol. 2011;1(2):60-71. doi:10.1016/j.prro.2011.01.005 Keywords: Airway obstruction, palliative radiotherapy
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