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Aim: The gold standard of care for pancreatic adenocarcinoma is the integrated treatment of surgery and chemotherapy (ChT), but about 50% of patients present with unresectable disease. Our study evaluated the efficacy in terms of local control, survival and safety of stereotactic body radiation therapy (SBRT) in locally advanced pancreatic cancer (LAPC). Methods: A retrospective study (STEP study) analyzed patients with LAPC treated with a dose of 45 Gy in 6 fractions. Local control (LC), distant progression free survival (DPFS), overall survival (OS) and toxicity were analyzed according to the Kaplan-Meier method. Results: A total of 142 patients were evaluated. Seventy-six patients (53.5%) received induction ChT before SBRT. The median follow-up was 11 months. One-, 2- and 3-year LC rate was 81.9%, 69.1% and 58.5%. Median DPFS was 6.03 months; 1- and 2-year DPFS rate was 19.9% and 4.5%. Median OS was 11.6 months and 1-, 2- and 3-year OS rates were 45.4%, 16.1%, and 9.8%. At univariate analysis, performed by the log-rank test, age < 70 years (p = 0.037), pre-SBRT ChT (p = 0.004) and post-SBRT ChT (p = 0.019) were associated with better OS. No patients experienced G3 toxicity. Conclusion: SBRT represents an effective and safe therapeutic option in the multimodal treatment of patients with LAPC in terms of increased LC. When SBRT was sequentially integrated with ChT, the treatment proved to be promising in terms of OS as well. [ABSTRACT FROM AUTHOR]

Aims: Despite the proved efficacy of Stereotactic Body Radiation therapy (SBRT) in hepatocellular carcinoma (HCC), this treatment is not included in major international guidelines at any stage, mainly due to the absence of prospective randomized studies. SBRT is commonly reserved for patients with unresectable disease, or in cases of lesions located near large vessels, just below the diaphragm, or larger than 4 cm. The aim of this study was to analyze the results of a large monocentric group of HCC patients treated with SBRT, assessing the impact of this approach on the clinical outcome. Material and methods: All HCC patients treated with SBRT between 2010 to 2020 at our Institution were retrospectively assessed. Patients with up to 4 liver lesions, any maximum diameter and no extrahepatic metastases were included in our analysis. The gross tumour volume (GTV) coincided with the clinical target volume (CTV). The internal target volume (ITV) was generated by the CTV considering all the different respiratory phases to CT-scans. The Planning target volume (PTV) consisted of ITV plus an isotropic margin of 5 mm. Patients were treated with a dose of 40-75 Gy in 3-10 fractions using the technique of modulated arc volumetric therapy in its RapidArc form and flattening filter-free beams. Local control (LC) and overall survival (OS) were calculated. Results: Overall, 133 patients for a total of 245 lesions were included. The details are described in Table 1. At a median follow-up of 19 months (range 3–100), 56 patients were alive (42.1%). One- and 2-years rates of LC were 87.9% (95% CI 81.1–92.4) and 79.5% (95% CI 69.0–86.8). In terms of OS, the 1- and 2-years rates were 78.6% (95% CI 69.8–97.6) and 48% (95% CI 37.2–58). In multivariate analysis, previous liver surgery (HR 0.74, 95% CI 0.27-0.85; p 0.012) HBV-related infection (HR 1.61, 95% CI 2.19-11.46; p 0.0001) and radiological response after SBRT (HR 0.29, 95% CI 1.13-1.57; p 0.0006) were significantly correlated with prolonged OS. No association was found between LC and patients/disease characteristics in Cox proportionalhazard regression analysis. Globally, SBRT was well tolerated with no grade 4 or 5 toxicity. Conclusions: Our analysis confirms the efficacy of SBRT in the treatment of HCC patients with an acceptable toxicity profile. [ABSTRACT FROM AUTHOR]

For resectable pancreatic tumors surgery is the gold standard of care, however more than 50% of patients are unresectable at the time of diagnosis. In patients with bordeline resectable/locally advanced pancreatic cancer, the integration of chemotherapy and chemo-radiation treatment, also as neoadjuvant treatment, is the current therapeutic option. The standard fractionation of the radiotherapy treatment is associated with a significant toxicity rate and with a disappointing overall survival. Higher local control related to the high doses employed, short overall treatment time and sequential integration with systemic therapy, represent the crucial advantages of SBRT over conventional CRT. Methods: After multidisciplinary board evaluation, patients with inoperable pancreatic cancer with maximum tumor diameter ≤ 5cm, N0 and M0 were treated with SBRT. Prescription dose was 45Gy in 6 fractions. Radiotherapy treatment plan was based on 3 phases 4D contrast enhanced simulation CT-scan and if necessary image registration of PET-CT or MRI. ITV of the lesion and Organs at risk were contoured on the simulation CTscan in all phases of the breath. Primary end-point was freedom from local progression (FFLP). Secondary endpoints were overall survival, progression-free survival, and toxicity. Local control was defined according to RECIST v1.1 criteria. Acute and late toxicity was scored according to the NCI Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Results: Between January 2011 and June 2021, 142 patients with pancreatic cancer were treated with SBRT at Humanitas Cancer Center. Median age was 71 years (range 41-91 years). 14 patients (9.8%) presented a borderline resectable disease and 128 patients (90.2%) a locally advanced disease. 76 patients (53.5%) received induction CHT before SBRT, for a median time of 5 months (range 3 - 10 months). FFLP was 81.9%, 69.1% and 58.5% at 1, 2 and 3 years, respectively. Median OS was 11.6 months and 1-2-3 years OS rates were 45.4% (95%CI 37.0 – 53.5), 16.1% (95%CI 10.5 – 22.9) and 9.8% (95%CI 5.4 – 15.7), respectively. CHT administered before SBRT (HR 0.59, 95%CI 0.41–0.84, p=0.004) and CHT post-SBRT (HR 0.63, 95%CI 0.43–0.92, p=0.019) were significantly correlated with OS. No case of Grade 3 toxicity was detected. Conclusions: SBRT is an effective and safe local therapy for selected patients with inoperable pancreatic cancer. Since OS was improved in patients pre-treated with induction CHT, our results suggest that the treatment for these patients must be multimodal and the stereotactic treatment may be a promising therapeutic option in this multi-modality context. [ABSTRACT FROM AUTHOR]

Background: In recent years SBRT has emerged as a valid alternative to invasive treatments in the oligometastatic setting, guaranteeing excellent local control and limited side effects. Nevertheless the literature regarding treatment of adrenal gland metastases is still based on retrospective data. Materials and methods: We included in the present trial patients affected by adrenal gland metastases from solid primary cancers. Dose prescription was 45 Gy delivered in 3 consecutive fractions. Clinical Target Volume (CTV) was delineated as the visible tumor on the 4D-CT simulation images. Planning Target Volume (PTV) was obtained with isotropic expansion of 5 mm from CTV. Primary end-point was to evaluate local control (LC) of the treated lesion. Secondary end-points were acute and late toxicity as well as endocrine setting, progression free survival (PFS), and overall survival (OS). In-field and out-field progression were recorded. Results: Thirty-six patients were enrolled from 2017 to 2020. Most common primary tumor was located in the lung (58.3%), followed by skin (11.1%) and kidney (8.3%). Median diameter of the treated lesions was 4.1 cm (range 2.2–6.7), and median volume was 25cc (range 3–69.4). With a median follow-up of 9.5 months (range 3–41.3), LC rates at 1 and 2 years were 94.7% (95%CI 68.1–99.2) and 88.4% (95%CI 60.8-97.0). Median LC was not reached. PFS rates at 1 and 2 years were 50.5% (95%CI 29.2–68.5) and 29.8% (95%CI 10.1–52.7%). Median PFS time was 14.7 months. OS at 1 and 2 years were 62.9% (95%CI 42.7–77.6) and 44.1% (95%CI 23.7–62.7). Median OS was 23.4 months. At univariate analysis, non-oligorecurrence was associated with worse OS (HR 4.33, 95%CI 1.23–15.2; p=0.022). Regarding hormonal production from the adrenal glands only a mild variation was shown after the treament. Conclusion: SBRT is confirmed to be a feasible and effective technique with minimal toxicities and acceptable alteration of the hormonal production. [ABSTRACT FROM AUTHOR]

Background: In oligometastatic colorectal cancer (CRC), stereotactic body radiation therapy (SBRT) represents a valid non-invasive local ablative treatment with high rates of local control (LC) and a low toxicity profile. This literature review was performed to evaluate the clinical benefit and toxicity of SBRT on non-liver metastases in CRC oligometastatic patients., Methods: After searching PubMed, Medscape and Embase databases, 18 retrospective studies focused on body oligometastases excluding bone metastases were included in the analysis., Results: A total of 1,450 patients with 3,227 lung metastases and 53 patients with 66 nodes lesions were analyzed. BED10 ranged from 76 to 180 Gy. In the lung group, the LC rate was 62-91%, 54-81% and 56-77% after 1, 3 and 5 years, respectively. In the nodes group, the 3-year LC rate was 65-75%. The 1-, 3- and 5-year OS rates were 73-100%, 51-64% and 34-43%, respectively for the lung group, and 63-81% at 3 years for the nodes group., Conclusions: In CRC patients with non-liver oligometastases, the use of SBRT is effective and safe reaching high LC and survival, with few severe side effects. However, prospective randomized studies are needed to validate the results. These studies will also be useful for identifying any predictive factors that allow us to select the subgroup of patients who benefit from SBRT., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-22-832/coif). The series “Precision Radiation Oncology in GI Cancers” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare., (2024 Journal of Gastrointestinal Oncology. All rights reserved.)