{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:53:25Z","timestamp":1791003205304,"version":"4.1.0"},"reference-count":72,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AstraZeneca"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Purpose: Chemoradioimmunotherapy (CRIT) with 60\u201366 Gy is the standard of care (SoC) for non-small-cell lung cancer (NSCLC) UICC stage III. The aim of this real-world data (RWD) study was to report the long-term impact of Durvalumab and radiation dose escalation on clinical outcomes. Material and Methods: ALLSTAR is a nationwide prospective multicentre registry for NSCLC UICC stage III, in which 12\/14 Austrian centres participated (ethics approval number: 1002\/2019). The basis for the current analysis is the third data extraction, which was completed on 2 June 2025. Apart from the SoC, alternative dose-fractionation and sequential CRT concepts &gt;66 Gy were also permitted. Durvalumab maintenance treatment for one year was administered at the discretion of the tumour board at each centre. Results: Compared to prior analyses by our group, 40 individuals who completed follow-up (FUP) were added to this final analysis, leading to a total patient population of 228 (156 CRT plus Durvalumab; 72 CRT). In 156 patients, Durvalumab was added to CRT, while 72 received CRT only. The median FUP periods were 41.0 (95%-CI: 36.7\u201345.4) and 37.8 months (95%-CI: 31.4\u201344.1) for the Durvalumab and CRT cohort, respectively. Radiation dose escalation combined with Durvalumab treatment was associated with a nominally higher ITC of 37 months (95%-CI: 24.5-not reached) compared with 17.7 months (95%-CI: 14.9-not reached) in patients receiving neither dose escalation nor Durvalumab (N = 135; HR = 0.61; 95%-CI: 0.37\u20131.006; p-value 0.051). With Durvalumab maintenance, a median PFS of 22.8 months (95%-CI: 19.4\u201338.3) was observed compared to 16.5 months (95%-CI: 12.6\u201324.5) without (N = 228; HR = 0.61; 95%-CI: 0.42\u20130.88; p-value 0.0071). Median OS was 52.6 months (95%-CI: 39.5-not reached) with Durvalumab compared to 27.4 months (95%-CI: 18.7-not reached) without (N = 228; HR = 0.52; 95%-CI: 0.34\u20130.78; log-rank p-value &lt; 0.002). Median time to death or distant metastasis (TTDM) was 33.3 months (95%-CI: 23.5\u201345) in the Durvalumab cohort compared to 18.7 months (95%-CI: 14.8-not reached) in the CRT cohort (N = 228; HR = 0.60; 95%-CI: 0.42\u20130.89; log-rank p-value 0.01). Median time to death or local relapse (TDLR) with Durvalumab was 30.4 months (95%-CI: 23.5\u201351.1) compared to 17.2 months (95%-CI: 14.8\u201325.7) without (N = 226; HR = 0.58; 95%-CI: 0.40\u20130.83; log-rank p-value &lt; 0.003). Conclusion: This final RWD analysis implies both a beneficial effect of high-dose irradiation combined with Durvalumab on ITC and the long-lasting impact of Durvalumab on PFS, OS, TTDM, and TDLR.<\/jats:p>","DOI":"10.3390\/cancers18193173","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T18:43:24Z","timestamp":1790880204000},"page":"3173","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Durvalumab Plus High-Dose Radiation in NSCLC III: Long-Term Results from the Austrian Radio-Oncological Lung Cancer Study Association Registry (ALLSTAR)"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5362-5859","authenticated-orcid":false,"given":"Katharina","family":"H\u00f6rmandinger","sequence":"first","affiliation":[{"name":"Comprehensive Cancer Centre, Department of Radiation Oncology, Medical University Innsbruck, A-6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7686-1008","authenticated-orcid":false,"given":"Elvis","family":"Ruznic","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Paracelsus Medical University, A-5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marisa","family":"Klebermass","sequence":"additional","affiliation":[{"name":"Klinikum Ottakring, A-1160 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2454-7425","authenticated-orcid":false,"given":"Brane","family":"Grambozov","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Paracelsus Medical University, A-5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Feurstein","sequence":"additional","affiliation":[{"name":"Klinikum Ottakring, A-1160 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef","family":"Karner","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Paracelsus Medical University, A-5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8357-5439","authenticated-orcid":false,"given":"Georg","family":"Gruber","sequence":"additional","affiliation":[{"name":"Ordensklinikum Linz, A-4010 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Heilmann","sequence":"additional","affiliation":[{"name":"Comprehensive Cancer Centre, Department of Radiation Oncology, Medical University Vienna, A-1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Falk","family":"R\u00f6der","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Paracelsus Medical University, A-5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ute","family":"Ganswindt","sequence":"additional","affiliation":[{"name":"Comprehensive Cancer Centre, Department of Radiation Oncology, Medical University Innsbruck, A-6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danijela","family":"Minasch","sequence":"additional","affiliation":[{"name":"Comprehensive Cancer Centre, Department of Radiation Oncology, Medical University Innsbruck, A-6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5931-3907","authenticated-orcid":false,"given":"Franz","family":"Zehentmayr","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Paracelsus Medical University, A-5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"ref_1","first-page":"209","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. 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