S850
Clinical - Lung
ESTRO 2026
Poster Discussion 4614 Multi-omics integrative modelling for SBRT in early-stage NSCLC: report on the first 194 patients of the MONDRIAN study (NCT05974475) Stefania Volpe 1,2 , Michela Onza 1 , Gaia Piperno 1 , Luigi Cornacchia 1,2 , Ilaria Repetti 1 , Paola Fulghieri 3 , Lucia Palumbo 4 , Alfonso Zappia 3 , Konstantinos Venetis 4 , Etjona Mane 4 , Mariano Lombardi 4 , Maria A Zerella 1 , Maria G Vincini 1 , Sabrina Clobiaco 1 , Cristiana I Fodor 1 , Stefano M Donghi 5 , Giuseppina Bonizzi 6 , Tiziana Bonaldi 3 , Nicola Fusco 4 , Monica Casiraghi 7,2 , Lorenzo Spaggiari 7,2 , Roberto Orecchia 8 , Barbara A Jereczek- Fossa 1,2 1 Radiation Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy. 2 Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy. 3 Department of Experimental Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy. 4 Division of Pathology, Istituto Europeo di Oncologia IRCCS, Milan, Italy. 5 Division of Interventional Pulmonology, Istituto Europeo di Oncologia IRCCS, Milan, Italy. 6 Biobank for Translational and Digital Medicine, Istituto Europeo di Oncologia IRCCS, Milan, Italy. 7 Department of Thoracic Surgery, Istituto Europeo di Oncologia IRCCS, Milan, Italy. 8 Scientific Directorate, Istituto Europeo di Oncologia IRCCS, Milan, Italy Purpose/Objective: MONDRIAN (Multi-omics Integrative Modelling for Stereotactic Body Radiotherapy in Early-stage Non- small Cell Lung Cancer) is an observational real-world cohort study, with a data-driven, bottom-up approach aiming to identify a predictive multi-omic signature of response to stereotactic body radiation therapy (SBRT) in early-stage NSCLC. A surgical control arm has been foreseen to discriminate between predictive and prognostic biomarkers. The study integrates clinical data to information from the genomics, proteomics and quantitative imaging analysis domains. It is expected to enroll 100 treated with SBRT and 200 patients treated with surgery, with an overall expected duration of 60 months. Material/Methods: Eligible patients are adults with histologically confirmed ES-NSCLC, staged per the 8th edition of the TNM classification, ECOG performance status 0–1, no prior invasive malignancy within 3 years, and no contraindications to either surgery or SBRT. Patients unable to provide informed consent are excluded. For the purpose of this analysis, baseline clinical and tumor characteristics were compared between treatment arms. Continuous variables were summarized as median (interquartile range, IQR) and compared using the Mann–Whitney U test. Categorical variables were expressed as counts and percentages
divided into 3–4 zones according to lobes. Finally, 1 cm was subtracted from delta displacements to account
for the PTV–CTV margin, reflecting absolute displacement outside the PTV (see Figure 1).
Results: Maximum displacements were observed in the right lower lobe, reaching 3.7 cm in Z. Upper lobes had smaller displacements, with a maximum of 1.3 cm. In the left lung, maximum lower lobe displacement was 3.2 cm. Lateral (X) and vertical (Y) displacements were
consistently smaller than cranio-caudal (Z) displacements. Table 1 summarizes delta
displacements by lung region and axis. For example, a PTV in the right upper lobe, lateral zone 4 and vertical zone 4, would use 0.5 cm (X), 0.3 cm (Y), and 1.3 cm (Z) for plan uncertainty calculations (see Table 1).
Conclusion: This study quantifies lung displacements along the X, Y, and Z axes to inform uncertainty calculations in lung radiotherapy plans. The results highlight the variability of motion by lobe and axis and emphasize its potential
impact on dosimetric plan robustness. Keywords: Lung, Motion, Uncertainty
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