S909
Clinical - Mixed sites & palliation
ESTRO 2026
26%. Sequential systemic therapy was administered in 63%. After a median follow-up of 8.4 months, symptomatic assessment was available for 95% of patients: 72% reported subjective visual improvement, and ocular pain was resolved in all who experienced it. Median overall survival was 14.5 months (95% CI: 3.2–25.2).Detailed ophthalmologic reassessment at >6 months after RT was available in 47% of patients, with a median follow-up of 21 months in this subgroup. All lesions showed a reduction in both diameter and thickness (median decreases of 25% and 66% respectively), and macular edema resolved in 88%. Visual acuity improved in 56% of patients (median gain of 0.4 units) and remained stable in 44%, with no cases of deterioration. Local progression occurred in one patient at 19 months after radiotherapy (11% of long- term survivors). Chronic ocular toxicity was limited to cataract and xerophthalmia (one case each). Due to the limited number of evaluable patients, no prognostic factor analysis could be performed. Conclusion: Radiotherapy provides durable control of choroidal metastases and preservation or improvement of visual acuity in patients who survive long enough for ophthalmologic reassessment. Toxicity is generally mild, supporting the role of RT as a safe and effective therapeutic option Keywords: Choroidal metastases Digital Poster 4027 LINACS: Living systematic review and meta- analysis of toxicity following combined treatment with novel systemic therapy and stereotactic radiotherapy Nora Sundahl 1,2 , Esmée Lauren Looman 3 , Luc Ollivier 4 , Piet Ost 2,5 , Matthias Guckenberger 3 , Jeffrey M Ryckman 6 , Matthew M Culbert 7 , Geertruida E Bekkering 8 , Sabrina Reichl 3,9 1 Radiation Oncology, AZ Groeninge, Kortrijk, Belgium. 2 Human Structure and Repair, Ghent University, Ghent, Belgium. 3 Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 4 Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, France. 5 Radiation Oncology, Iridium Network, Antwerp, Belgium. 6 Radiation Oncology, West Virginia University, Morgantown, USA. 7 Radiation Oncology, University of Florida College of Medicine, Gainesville, USA. 8 Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium. 9 Laboratory of Applied Radiobiology, University of Zurich, Zurich, Switzerland
Purpose/Objective: The concurrent use of stereotactic radiotherapy (SRT) with novel anti-cancer drugs shows promise for improving oncological outcomes, including overall and progression-free survival, though it may increase risks of side effects1,2. However, an unanswered question in daily routine is how to combine novel anti-cancer drugs and modern metastases-directed SRT. The overall level of evidence is low, but rapidly evolving, such that systematic reviews and consensus efforts are rapidly outdated ¹ , ² . The present LINACS Study, endorsed by EORTC-ESTRO OligoCare consortium, aims to establish the methodology of a living systematic review and meta-analysis, about safety of combined systemic therapy and metastases-directed SRT. Material/Methods: A systematic literature search was conducted in PubMed (May 2025) following PRISMA guidelines. Search terms encompassed SRT (fraction dose ≥ 5Gy) and all licensed anti-cancer drugs approved from 2000 onwards, as catalogued by the Anticancer Fund. Duplicate records were removed using EndNote, while Laser AI software facilitated abstract and full-text screening. Extracted data included publication year, study design, patient and tumor characteristics, radiation dose and fractionation, concurrent therapy type and dosage, treatment timing, and toxicity graded according to CTCAE v5.0. This living review undergoes biannual updates to maintain currency. Results: The search identified 3,369 unique records. Following screening and risk-of-bias assessment, 292 manuscripts were included: 112 prospective studies, 108 retrospective studies, and 71 case reports (Fig 1). Notably, 138 studies (47%) were published from 2022 onwards, underscoring the field's rapid evolution (Fig 2). The most extensively studied drug classes include anti-PD(L)1 agents (n=145), tyrosine kinase inhibitors (n=57), EGFR inhibitors (n=36), and MAPK inhibitors (n=34). Anti-body drug conjugates (ADCs) as an example: For ADCs, five articles were identified (total number of patients=93).3-7 These show that concurrent intracranial SRT with trastuzumab emtansine, trastuzumab deruxtecan, or sacituzumab govitecan leads to an increased risk of radiation necrosis.3-6 Conversely, data regarding extracranial SRT with concurrent ADCs remain insufficient for definitive safety conclusions.7Comprehensive meta- analyses of toxicity profiles across all drug classes will be presented at the ESTRO congress.
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