S921
Clinical - Mixed sites & palliation
ESTRO 2026
expectations. Most symptomatic cases were managed with corticosteroids (n = 6), and two required bevacizumab. Conclusion: RN after HF-SRT occurred in approximately 14% of evaluable lesions, predominantly as late symptomatic events. Prior surgical resection was the strongest predictor, conferring a >20-fold increased risk compared to intact metastases. PTV volume showed a non-significant trend toward higher risk in our series. Patients treated in surgical cavities may benefit from closer clinical and imaging follow-up. References: Patel KR et al. Multi - institutional analysis of hypofractionated stereotactic radiotherapy to resection cavities in brain metastases. JAMA Oncol. 2021;7:827 - 835.Minniti G et al. Risk of radiation necrosis after hypofractionated stereotactic radiotherapy for brain metastases: single-center study. J Neurooncol. 2020;148:365 - 374.Mayo ZS et al. The dilemma of radiation necrosis from diagnosis to treatment in brain metastases. Neuro Oncol.2024;26(Suppl 2):S56 - S65.Mayo ZS et al. Radiation necrosis or tumor progression? Review of imaging modalities for cerebral radiation necrosis. J Neurooncol. 2023;161:23 - 31. Keywords: Radionecrosis, brain metastases Geriatric Assessment in Radiation Oncology Outpatient Department: Feasibility and Clinical Relevance Vaishali Kataria 1,2 , Shikha Goyal 2 , Bhavana Rai 2 , Srinivasa G.Y. 2 , Kriti Dhiman 2 , Sushmita Ghoshal 2 1 Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India. 2 Radiotherapy and Clinical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India Purpose/Objective: Geriatric population constitutes approximately half of the cancer patients yet remains underrepresented in clinical trials. Most radiation oncology centers lack dedicated geriatric services, and treatment protocols inadequately incorporate age and frailty assessment for shared decision-making. We prospectively evaluated patients aged ≥ 65 years presenting to radiation oncology (RO) outpatient clinic to (a) determine feasibility of geriatric assessment (GA) by ROs during first consultation, (b) estimate proportion of frail elderly patients who need a more comprehensive evaluation and (c) clinical correlation of GA scores with treatment intent, toxicity, and Digital Poster 4585
high-dose corticosteroid therapy. References:
1. Nielsen AM, Laursen MRT, Rechner LA et al. Esophagus-sparing radiotherapy for complicated spinal metastases (ESO-SPARE). A randomized phase III clinical trial. Radiother Oncol. 2025 Jun;207:110906. doi: 10.1016/j.radonc.2025.110906.2. Chow E, Hoskin P, Mitera G, et al. International Bone Metastases Consensus Working Party. Update of the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases. Int J Radiat Oncol Biol Phys. 2012 Apr 1;82(5):1730-7. doi: 10.1016/j.ijrobp.2011.02.008. Keywords: Spinal metastases, pain, randomized clinical trial Incidence and Predictive Factors of Radionecrosis After Hypofractionated Stereotactic Radiotherapy for Brain Metastases: A Retrospective Analysis Luisa M Díaz, Laura M Álvarez, Sonia Almendros, Anabel Mañes, Josep Jove, Ernest Luguera, Jaume Molero, Isabella Vargas, Jefferson Moreno, Eva Ortiz, Silvia Comas Radiation Oncology, ICO Badalona, Barcelona, Spain Purpose/Objective: To evaluate the incidence, clinical presentation, and predictive factors of radionecrosis (RN) in patients with brain metastases treated with hypofractionated stereotactic radiotherapy (HF-SRT). Material/Methods: We retrospectively analyzed 113 brain metastatic lesions treated with HF-SRT between 2015 and 2021 in one single institution. Seventy lesions (61.9%) had post-treatment MRI follow-up and were evaluable for RN. The most commonly used prescribed dose was 27 Gy in 3 fractions. RN was assessed radiologically and Digital Poster 4564 clinically. Associations between RN and clinical– dosimetric variables were explored using Fisher’s exact and Mann–Whitney U tests. Results: RN was detected in 10 of 70 evaluable lesions (14.3%; 95% CI, 7–25%), consistent with published data. Eight cases (80%) were symptomatic. The median time to RN diagnosis was 23 months (range, 5.6–37 months). Most RN cases (8/10, 80%) occurred in resection cavities, representing a markedly higher risk than in intact lesions (OR ≈ 22.6; p < 0.0001). No significant differences were found by primary tumor type (p = 0.46) or PTV volume (median 21 cc vs 18 cc; p = 0.65) in our series, though a trend toward larger volumes among RN lesions aligned with radiobiological
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