S935
Clinical - Mixed sites & palliation
ESTRO 2026
Results: The significant effect of metastases number on OS in Figure 1, also shows long term survival of a 10+ metastasis subset, (seen again in our second cohort). 387 SRS/SRT encounters between 2020-25, were delivered to 267 unique patients. 190 of them had one course of treatment, 47 had 2 courses, and 30 had “multiple” (three or more) courses (19 having 3; 8 having 4; 2 having 5 and 1 having 6 courses.) 16 of the 23 “multiple-course” patients, with available outcome data, were still alive.
treatment journeys. However, we also established a difference in meaninterval between courses in the “2 course” and the “3+ course” groups; 245.1 vs 295.8 days respectively. The effect was non-significant (p=0.329) but equally the converse pattern we might have expected, whereby patients requiring more treatments might have more aggressive disease was not demonstrated. Conclusion: We have demonstrated good outcomes in patients treated for many metastases and up to 6 courses. SRS can no longer be limited for those with few metastases: a subset of patients perform well despite these, returning for multiple further treatments.How to stratify long-term benefit, beyond crude measures like volume and ECOG PS? We need strategies to understand disease-dynamics embedded from the outset, to establish a high-quality evidence base to address these questions. Keywords: SRS, metastases, stratification Determinants of Graded Prognostic Assessment predictive accuracy in lung and breast cancer brain metastases treated with whole-brain radiotherapy Claudia Laborda 1 , Ana Galán 1 , Claudia Colom 1 , Andrea Ochoa 1 , Tomás Gonzalez 2 , Javier Diez 2 , Maria Cerrolaza 1 , Javier Tomás Anchuelo 1 , Reyes Ibañez 1 1 radiation oncology logy, HUMS, zaragoza, Spain. 2 Physics, HUMS, Zaragoza, Spain Purpose/Objective: To identify clinical factors associated with major deviation between GPA-estimated and observed survival in patients with brain metastases from lung or breast cancer treated with whole-brain radiotherapy (WBRT). Material/Methods: We retrospectively analyzed WBRT-treated patients with primary lung or breast cancer. For each patient, the diagnosis-specific GPA and the corresponding estimated survival were computed; observed survival was retrieved from follow-up. The difference was categorized as mild ( ≤ 4 months), moderate (5-8), or Digital Poster 5133 severe deviation ( ≥ 9). A multivariable logistic regression was fitted with severe deviation as outcome and the following predictors: tumor type (breast vs lung), Karnofsky Performance Status (KPS; 1=90–100, 2=70–80, 3 ≤ 60; higher=worse), extracranial disease (1=yes, 0=no), GPA index (continuous), and age. Results: Severe deviation occurred more frequently in breast
Tumour type was relevant - almost half “multiple- course” patients had breast cancer, a third lung, 10% melanoma (in line with the whole cohort), with other diagnoses less represented. Notably number of metastases per course was unrelated to number of courses (Figure 2).
Logically “multiple-course” patients had longer overall
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