S3045
Invited Speaker
ESTRO 2026
5. Bilski et al. HDR brachytherapy vs robotic and linac SBRT for liver metastases – dosimetric comparison. Clin Transl Radiat Oncol 2024.
robotic-based) were performed to assess target coverage and organ-at-risk (OAR) sparing (5). Across CRC cohorts, including one of the largest reported series in repeat oligoprogression (n=127), median OS was 16 months, with 1-year OS rates of approximately 65% and low rates of grade ≥ 3 toxicity (~4%) (1-3). In induced oligoprogression settings, disease control rates exceeded 80%, with minimal severe toxicity (3). In oligometastatic BC (BRALIBREST multicenter cohort), median OS reached 37 months, with 2-year OS rates of 60% and disease control rates exceeding 90%, confirming high efficacy in selected patients (4). Dosimetric analyses consistently demonstrated more favorable dose distributions with HDR brachytherapy compared to SBRT, including improved target dose coverage (Dmean, D50, D90) and reduced irradiation of uninvolved liver tissue and several critical OARs (5). These differences reflect the intrinsic advantage of intratumoral dose delivery without the need for large planning margins. CT-guided interstitial HDR brachytherapy is an effective and safe metastasis-directed therapy for liver oligometastases across multiple oligometastatic clinical scenarios, including de novo, repeat oligoprogression, and induced oligopersistence. Its favorable dosimetric profile compared to SBRT supports its role as a complementary or alternative ablative modality, particularly in anatomically challenging lesions and heavily pretreated patients. The ability to deliver ablative intratumoral doses with no margins enables precise treatment while preserving uninvolved liver parenchyma, which is of particular importance in patients undergoing repeated local therapies. In addition, this approach may facilitate continuation or delay of systemic treatment, representing a clinically meaningful advantage in the multidisciplinary management of oligometastatic disease.These findings support the integration of interventional radiotherapy into modern metastasis- directed treatment strategies and provide a strong rationale for prospective comparative studies. References: 1. Bilski et al. Comprehensive cohort study: CT-guided HDR brachytherapy for liver metastases from colorectal cancer in repeat oligoprogression. Radiol Med 2025. 2. Cisek et al. CT-guided HDR brachytherapy for induced oligoprogression of colorectal cancer liver metastases. Sci Rep 2025. 3. Cisek et al. EORTC/ESTRO-defined induced oligopersistence of CRC liver metastases-outcomes of CT-guided HDR brachytherapy. Clin Exp Metastasis 2025. 4. Bilski et al. CT-guided HDR brachytherapy for liver oligometastases in breast cancer (BRALIBREST). Radiother Oncol 2026.
5454 The oncologist perspective Suraiya R Dubash oncology, Mount Vernon Cancer Centre, London, United Kingdom Thirty years ago, SBRT for inoperable early-stage lung cancer was a proposition built on radiobiological logic and clinical courage and for those patients, the options were few. Today, it stands as one of the most technologically advanced and widely adopted interventions in thoracic oncology, delivering outcomes that rival surgery, applicable across multiple lesions and disease settings, and embedded in multidisciplinary decision-making at every stage of the lung cancer pathway. This session takes stock of that transformation, tracing the milestones, interrogating the evidence, and making the case for why lung SBRT represents one of the most significant advances in thoracic oncology of the past three decades while asking, what remains unresolved and what the next decade must address. The radiobiological principles underpinning ablative fractionation will be revisited considering dosimetric and clinical data, with particular focus on the persistent challenges of central and ultra-central disease, where the balance between tumour control and toxicity remains one of the defining technical and clinical questions in the field. The expanding indications for lung SBRT will be addressed, from multiple synchronous primaries to oligometastatic and oligoprogressive disease reflecting a paradigm shift in how we define and treat radical intent lung cancer management. The emergence of advanced adaptive platforms is redefining treatment precision, enabling real-time biological and anatomical adaptation individualised to a degree previously unattainable, and raising new questions about optimal implementation and patient selection. The session will close by mapping the road ahead: the evolving trial landscape, the role of AI in auto- segmentation, adaptive planning and outcome prediction, and the integration of biological, functional, and imaging biomarkers into treatment decision- making. Thirty years on, lung SBRT is not a mature technique resting on its achievements. It is a field in motion and this session charts where the evidence, the technology, and the patients are taking it next.
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