S924
Clinical - Mixed sites & palliation
ESTRO 2026
Per Munck af Rosenschold 1,2 , Viktor Rogowski 1,2 , Mia Lind 1 , Petronella Lannerheim 1 , Elisabeth Rasmusson 3 , Silke Engelholm 3 1 Radiation Physics, Dept of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden. 2 Medical Radiation Physics, Lund University, Lund, Sweden. 3 Oncology, Dept of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden Purpose/Objective: To describe real-world utilisation patterns, short-term mortality, and survival following palliative intent radiotherapy (RT) for bone metastases patients with Eastern Cooperative Oncology Group (ECOG) performance status (PS) 3–4. Material/Methods: All palliative-intent RT courses between January 2020 and October 2025 for bone metastases were extracted from the institutional record and verification system. ECOG PS was assessed at the time of the RT start. Overall survival was measured from the final day of RT to death/censoring (Kaplan-Meier, months). Early mortality endpoints were defined as death ≤ 14 days and death ≤ 30 days from RT completion. Potential prognostic predictors for mortality (PS, single-fraction use, site, sex, course duration) were evaluated with Cox regression and multivariable logistic regression. Results:
early death for both 14- and 30-days mortality (p<0.001). Single-fraction vs multi-fraction, sex, the number of previous radiotherapy courses, and course duration were not significant after adjustment. Kaplan–Meier curves showed clear separation by PS with the steepest early decline for PS 3-4. Median survival (months) were 9-10 months for PS3 and PS4 (see figure 1). Cox regression revealed that lower total dose and worse performance status was associated with inferior prognosis for the full cohort with PS 0-4. On the last RT course before death the 14-day and 30- day mortality for patients with PS 3 or 4 was 11.8% and 32.1%, respectively. Conclusion: In this large palliative-only cohort, patients with PS 3– 4 experienced higher very-early and 30-day mortality than PS 1–2, yet rates remained within acceptable quality ranges under a practice dominated by 8 Gy in 1–2 fractions. A longer treatment schedule (with larger total dose) tended to be selected for patients with better prognosis. PS3-4 is the key short-term prognostic signal; routine use of ultra-short schedules enables low-burden palliation even in very frail patients. Keywords: Palliative radiotherapy Acute toxicity of hypofractionated Proton therapy: report from the European Institute of Oncology Daniela Alterio, Maria Giulia Vincini, Annamaria Ferrari, Giulia Marvaso, Gaia Piperno, Stefania Volpe, Giovanni Carlo Mazzola, Luca Bergamaschi, Karl Amin, Federico Mastroleo, Federica Cattani, Stefania Comi, Floriana Pansini, Marco Liotta, Roberto Orecchia, Barbara Alicja Jereczek-Fossa Radiation Oncology, IEO, IRCCS, Milan, Italy Digital Poster 4693 Purpose/Objective: Hypofractionation (dose/fraction > 2Gy/fr RBE) represents a field that is little explored in the setting of proton therapy (PT) . Aim of this work was to report feasibility and acute toxicity profile of patients treated with hypofractionated (Hypo) PT at the Proton Center of the European Institute of Oncology, IRCCS, Milan, Italy. Material/Methods: All consecutive patients (pts) treated with Hypo PT between November 2023 and June 2025 were retrieved. Toxicity has been defined at the end of the treatment using Common Terminology Criteria Adverse Event (CTCAE V4.0) scale. Data have been prospectively collected in a proton registry (“Power Registry” NCT0586036).
Among patients with PS evaluation available, there were 1503 patients and 2040 treatment courses. Ultra- short schedules (8 Gy in 1-2 fractions) were used in 71% overall, and 90% for patients with PS 3–4. The 14-day and 30-day mortality was 7.8% and 19.5%, for the full cohort and for patients with PS 3 or 4, respectively. On multivariate logistic regression analysis to find risk of early mortality (PS 1 reference), poor PS was the dominant predictor of
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