A1084
Title: Assessing causal effects of radiation toxicity on overall survival
Authors: Gilmer Valdes - UCSF (United States) [presenting]
Abstract: The causal effects of radiation-induced toxicities are investigated on overall survival (OS) in stage III non-small cell lung cancer (NSCLC) patients undergoing proton radiation therapy. Utilizing real-world data (RWD) from the Registry Study for Radiation Therapy Outcomes and advanced causal inference methodologies supported by the US Food and Drug Administration's Real-World Evidence (RWE) Program, the impact of pneumonitis/dyspnea and esophagitis/dysphagia is estimated on OS using targeted minimum loss-based estimation (TMLE). Results indicate a potential time-dependent relationship between pneumonitis/dyspnea and reduced OS, highlighting the importance of personalized treatment strategies that balance treatment intensity with toxicity management. Furthermore, the approach demonstrates the value of targeted learning and its systematic causal roadmap in generating reliable RWE. This sets a precedent for applying these techniques in radiation oncology to support clinical and regulatory decision-making and ultimately improve patient care.
