Lung metastases are the second most common malignant neoplasms of the lung. It is estimated that 20–54% of cancer patients have lung metastases at some point during their disease course, and at least 50% of cancer-related deaths occur at this stage. Lung metastases are widely accepted to be oligometastatic when five lesions or less occur separately in up to three organs. Stereotactic body radiation therapy (SBRT) is a noninvasive, safe, and effective treatment for metastatic lung disease in carefully selected patients. There is no current consensus on the ideal dose and fractionation for SBRT in lung metastases, and it is the subject of study in ongoing clinical trials, which examines different locations in the lung (central and peripheral). This review discusses current indications, fractionations, challenges, and technical requirements for lung SBRT.

There are limited patient-reported outcome (PRO) data tracking changes in toxicity in patients actively undergoing radiotherapy. Between 2015–2019, acute toxicity was prospectively measured in 698 patients undergoing a 5-week course of pelvic radiotherapy for gynecologic cancers using a weekly PRO questionnaire. Our questionnaire was able detect a pattern of onset and resolution of acute gastrointestinal (GI) and genitourinary (GU) toxicity in 27 out of 32 questions. Logistic regression analysis showed that increasing GI and GU toxicity at week 2 could predict for severe toxicity at week 5. However, due to a low number of severe events, univariate results could not be productively added to a multivariate model. We observed a >70% response rate for all sections of the questionnaire, except for questions on sexual and vaginal health, which had a 13% average response rate. By demonstrating that PRO data can be used to track acute toxicity during radiotherapy, there is a need to further examine how this tool may be implemented in the clinic to provide complex, adaptive care, such as early side effect management, and modifying radiation delivery in real-time.

We assessed whether advanced RT techniques were associated with differences in patient-reported outcomes (PROs). Patients with bone metastases who completed the brief pain inventory (BPI) before and after RT were identified, and RT technique was categorized as simple (e.g., parallel opposed pair) or advanced (e.g., 3D-conformal RT (3DCRT), intensity-modulated RT (IMRT), or stereotactic ablative RT (SABR)). Pain response and patient-reported interference on quality of life secondary to pain was compared. A total of 1712 patients completed the BPI. From 2017–2021, the rate of advanced RT technique increased significantly (p < 0.001; 2.4%, 2.4%, 9.7%, 5.5%, 9.3%), with most advanced techniques consisting of IMRT, and only 7% of advanced techniques were SABR. Comparing simple vs. advanced technique, neither the complete pain response (12.3% vs. 11.4%; p = 0.99) nor the partial pain response (50.0% vs. 51.8%; p = 0.42) was significantly different. There was no significant patient-reported difference in pain interfering with general activity, mood, walking ability, normal work, relationships, sleep, or enjoyment of life. Given that there is increasing utilization of advanced RT techniques, there is further need for randomized trials to assess their benefits given the increased cost and inconvenience to patients.

9074 Background: We have proposed that best, worst, and typical scenarios for survival, based on simple multiples of an individual’s expected survival time (EST) estimated by their oncologist, are a useful way of formulating and explaining prognosis in advanced cancer. The aim of this study was to determine the accuracy and prognostic significance of such estimates in a multicenter, randomized trial. Methods: Oncologists recorded their estimate of the ‘expected survival time’ at baseline in each of 372 patients recruited in the NITRO trial. We hypothesized that oncologists’ estimates of EST would be well-calibrated (~50% of patients living longer or shorter than EST) and imprecise ( < 33% living within 0.75 to 1.33 time their EST), but provide accurate scenarios for survival time (~10% dying within a quarter of their EST, 10% living longer than 3 times their EST, and 50% living for half to double their EST). We also hypothesized that oncologists’ estimates of EST would be independently significant predictors of survival in a multivariable Cox model adjusting for traditional prognostic factors selected in the first 250 participants recruited, and validated in the remaining 122. Results: Oncologists’ estimates of EST were well calibrated (51% of patients lived longer than their EST), but imprecise (24% lived within 0.75 to 1.33 times their EST). Scenarios based on the oncologists’ estimates were accurate: 9% of patients died within ¼ of their EST, 12% lived longer than 3 times their EST, and 53% lived from half to double their EST. Oncologists’ estimates of EST were independently significant predictors of overall survival (HR 0.92, 95% CI 0.88 to 0.96, p < 0.001) in Cox models accounting for ECOG performance status, liver metastases, neutrophil to lymphocyte ratio, and anaemia. Conclusions: Oncologists’ estimates of EST were well calibrated, imprecise, and independently significant predictors of survival above and beyond traditional prognostic factors. Best, worst and typical scenarios for survival based on EST were remarkably accurate, and are a good solution to the problem of estimating prognosis in advanced cancer. Clinical trial information: ACTRN12608000588392.

Total body irradiation (TBI) is commonly used for myeloablative conditioning prior to allogeneic hematopoietic stem cell transplantation (HSCT) in high-risk, relapsed, or refractory hematologic malignancies. Pulmonary toxicity (PT)—including pneumonia, diffuse alveolar hemorrhage, and interstitial pneumonitis—is a serious complication after HSCT. Idiopathic pneumonia syndrome (IPS), defined as widespread alveolar injury without cardiogenic or infectious causes, represents a non-infectious form of PT. This study characterizes PT and IPS and explores associated factors following TBI-based HSCT in adults. We conducted a retrospective review of a prospectively collected database of adult patients treated with TBI-based HSCT from 2015 to 2022. Clinical records and chest imaging were reviewed to identify PT and IPS. IPS occurred in 20 patients (18%) of the cohort, with 8 patients (7%) within 100 days and 13 patients (13%) after 100 days. One patient experienced both early- and late-onset IPS and was counted once in the cumulative analysis. Early pulmonary infection was associated with reduced overall survival in both univariable (p = 0.002) and multivariable 100-day landmark analyses (p = 0.047). Acute graft-versus-host disease (GVHD) was independently associated with improved survival (p = 0.017), whereas chronic GVHD was not statistically significant in the landmark analyses. PT and IPS incidences were consistent with previously published adult TBI cohorts. While no significant clinical or radiation-related predictors of IPS were identified, pulmonary infection emerged as a predictor of inferior overall survival.