This document discusses the potential role of stereotactic body radiotherapy (SBRT) in treating various gastrointestinal (GI) cancers. It notes that SBRT has shown promise for hepatocellular carcinoma, liver metastases, cholangiocarcinoma, pancreatic cancer, and other tumor types based on initial results demonstrating low toxicity and high response rates. Short courses of high-dose SBRT may improve local tumor control and survival compared to conventional radiation therapy. However, more multi-centric prospective studies are still needed to further evaluate SBRT's effectiveness and safety profile for GI cancers.
2. Radiosurgery in pancreatic tumour & cholangiocarcinoma
- SBRT has potential role in HCC, liver mets, cholangiocarcinoma,
pancreas, Klaskin tumour, GIST
- Initial results are impressive with low toxicity, high response rate
- Short course, high dose radiation therapy will improve local control
and may improve survival function
- There is emerging data
3. Local Control after Whipple+ChemoRT
+ve margin (%) Local Failure (%)
GITSG 0 47
EORTC 19 51
ESPAC 28 63
CONKO 19 37
RTOG 34 25
6. Post OP R1 Resection
• Fiducials placed at surgery
• One planning CT with oral and IV contrast
• 1000cGy to +ve margins 3-4 weeks post OP
• 5040cGy 5-6 field IMRT6-8 weeks postOP
• Concurrent Xeloda
• Adjuvant Gemcitabine
BIDMC
12. Potential role of SBRTPotential role of SBRT
1. GIST with primary disease , nodal disease or metastasis
2. Neuroendocrine tumour in intestine, pancreas, nodal involvement
3. Low grade lymphomas with post-chemotherapy residual disease
4. Para-aortic nodal disease metastasis
13. SBRT in GI tumours
Summary
- SBRT has potential role in HCC, liver mets, cholangiocarcinoma,
pancreas, Klaskin tumour, GIST…
- Initial results are impressive with low toxicity, high response rate
- Short course, high dose radiation therapy will improve local control
and may improve survival function
- Need multi-centric prospective studies.
