S965
Clinical - Oligometastatic cancer
ESTRO 2026
as predictors of PFS. These findings support the utilizing of radiotherapy as a“line 1.5”treatment strategy to bridge first- and second-line therapy in the setting of OP-HCC. Keywords: hepatocellular carcinoma; oligoprogression
hepatocellular carcinoma (OP-HCC), for whom supporting evidence remains limited. In this study, we evaluated the efficacy and safety of progression- directed radiotherapy (PDRT) combined with ongoing first-line systemic therapy (FLST) in patients with OP- HCC. Material/Methods: Patients who developed OP-HCC during FLST were enrolled. All patients received PDRT with a biologically effective dose of at least 60 Gy (LQ model, α / β = 10) while continuing FLST. The primary endpoint was progression-free survival (PFS); secondary endpoints were overall survival (OS), objective response rate (ORR), disease control rate (DCR), duration of response (DOR), treatment-related toxicities (CTCAE v5.0), and quality of life (QoL). Results: From March 2024 through May 2025, 36 patients were enrolled from 10 cancer centers. At a median follow- up time of 10.9 months, median PFS time was 7.0 months (95% confidence interval 4.9–9.7), with 3-, 6-, and 9-month PFS rates of 73.7%, 64.0%, and 38.8%. Type of FLST and albumin-bilirubin (ALBI) grade at oligoprogression were independently associated with PFS. Median OS and DOR times were not reached; 1- year OS rates were 86.4%, and 3-, 6-, and 9-month DOR rates were 84.6%, 79.6%, and 70.8%. ORR and DCR were 64.7% and 98.0%, respectively. QoL measures generally remained stable, except for transient increases in fatigue and pain scores 1 month after PDRT. Adverse events (most grade 1-2) occurred in 10 patients (27.0%), including acute toxicity in 6 (16.7%) and late toxicity in 8 (22.7%); one patient developed grade 3 late abdominal pain. A swimmer plot summarizing the treatment course and each patient’s best response of target lesions is shown in Figure 1.
Proffered Paper 846
Optimizing oligometastatic disease management with circulating tumor DNA: a correlative analysis from the phase II randomized EXTEND trial Alexander D Sherry 1,2 , Shuqi Wang 3 , Suyu Liu 3 , Tharakeswara K Bathala 4 , Aaron Seo 2 , Kieko Hara 5 , Chul S Ha 6 , Jay Reddy 2 , Stephen G Chun 2 , Dan Zhao 7 , Amado Zurita 8 , Nizar Tannir 8 , Paul G Corn 8 , Bilal A Siddiqui 8 , Sumit K Subudhi 8 , Ethan B Ludmir 9,3 , Pavlos Msaouel 8,5 , Shuang G Zhao 10 , Peter Van Loo 11,12 , Phuoc T Tran 13 , Chad Tang 13,5 1 Department of Radiation Oncology, Mayo Clinic, Rochester, USA. 2 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 3 Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA. 4 Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, USA. 5 Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA. 6 Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, USA. 7 Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 8 Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 9 Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 10 Department of Human Oncology, University of Wisconsin-Madison, Madison, USA. 11 Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, USA. 12 Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA. 13 Department of Genitourinary Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
This abstract is part of the press programme and is embargoed until the congress.
Conclusion: Maintaining FLST with PDRT was effective and safe while preserving QoL; this strategy may be feasible for OP-HCC. FLST type and baseline ALBI grade may serve
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