S919
Clinical - Mixed sites & palliation
ESTRO 2026
1: Andratschke, Nicolaus et al. “European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus on re-irradiation: definition, reporting, and clinical decision making.” The Lancet. Oncology vol. 23,10 (2022): e469-e478. doi:10.1016/S1470- 2045(22)00447-8 Keywords: Re-Irradiation, MR-guided Radiotherapy, SBRT Proffered Paper 4504 Pain response after esophagus-sparing radiotherapy in spinal metastases: secondary analysis of the ESO-SPARE Trial Anna Mann Nielsen 1 , Sebastian Moretto Krog 1 , Michael Ruben Teindl Laursen 1 , Laura Ann Rechner 1 , Wiviann Ottoson 1 , Patrik Sibolt 1 , Morten Hiul Suppli 2 , Ivan Richter Vogelius 3 , Claus Behrens 1,4 , Gitte Persson 1 1 Department of Oncology, Copenhagen University Hospital – Herlev and Gentofte,, Herlev, Denmark. 2 Department of Oncology, Zaeland University Hospital – Naestved, Naestved, Denmark. 3 Department of Oncology, Copenhagen University Hospital – Rigshospital, Copenhagen, Denmark. 4 Dept. of Health Technology,, Technical University of Denmark, Lyngby, Denmark Purpose/Objective: The randomized phase III ESO-SPARE trial (NCT05109819) investigated whether esophagus- sparing volumetric-modulated arc therapy or intensity- modulated radiotherapy could reduce dysphagia in patients with spinal metastases.1 In the esophagus- sparing arm, the maximum esophageal D0.027cc was restricted to 8 Gy EQD2, compromising dose to the planning target volume (PTV) and clinical target volume. We hypothesized that this dose compromise would not result in inferior pain response compared with the standard-radiotherapy arm. The present analysis reports pain response outcomes at five and nine weeks. Material/Methods: Patients enrolled in the ESO-SPARE trial with a baseline numeric rating scale (NRS) pain score > 0 who provided a baseline score and at least one pain score at weeks five or nine were eligible for analysis. Pain response was evaluated according to the International Consensus on Palliative Radiotherapy Effectiveness criteria which integrate changes in pain scores and opioid consumption.2 The pain response rate was defined as the ratio of patients achieving a complete response or partial response among eligible patients.
tumor control remains challenging. Magnetic resonance image-guided radiation therapy offers the advantage of delivering high radiation doses precisely tailored to the tumor anatomy on treatment days, while sparing surrounding organs at risk. This study aims to evaluate the feasibility and efficacy of stereotactic magnetic resonance guided online adaptive radiotherapy (SMART) in type I and II re- irradiation. Material/Methods: Patient demographics, treatment parameters, and follow-up data of patients who underwent re- irradiation utilizing SMART at the Department of Radiation Oncology, Heidelberg University Hospital, were collected from a prospective database. Re- irradiation was classified according to the ESTRO and EORTC consensus1. Results: From November 2020 to September 2025, 53 patients with a total of 70 lesions underwent MR-guided (Re- )SBRT. Of the 70 treatments, 53 (75.7%) and 17 (24.3%) were classified as re-irradiation type I and II, respectively. At the time of first re-irradiation, the median age was 69.8 years. Median follow-up was 9.8 months. The most common primary tumors were prostate cancer (47.2%), non-small cell lung cancer (18.9%), and sarcoma (7.5%). Prior radiotherapeutic treatments were delivered with a median total dose of 60 Gy, predominantly utilizing normo- and hypofractionated IMRT and MR-guided SBRT. Median time interval between previous radiotherapy and re- irradiation was 35.2 months. Re-irradiation was conducted with a median of six fractions, a median of five Gy per fraction to a median surrounding isodose of 80%. In total, the median prescribed dose was 36 Gy. The median GTV, CTV and PTV measured 5.8 cc, 14.9 cc and 15.2 cc, respectively. The overall one year local control, progression-free survival, and overall survival rates were 80.7%, 33.2%, and 80.2%, respectively. Acute toxicities (within three months post re-radiotherapy) were observed in 42.9% of patients for CTCAE grade 1 and 11.4% for grade 2. Late toxicities (beyond three months post re-radiotherapy) were reported in 13% for grade 1 and 2.9% for grade 2, with only one case (1.4%) of grade 3 late toxicity (pneumonitis). Data on acute and late toxicity were unavailable in 5.7% and 30% of follow-ups,
respectively. Conclusion:
MR-guided re-irradiation demonstrates promising rates of local tumor control with moderate radiation- induced toxicity, supporting its use as a safe and effective modality for re-irradiation. References:
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