S1107
Clinical – Upper GI
ESTRO 2026
Pathological Sciences, Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy. 23 Department of Radiological Sciences, Radiotherapy Unit, Azienda Sanitaria Territoriale Pesaro Urbino, Pesaro, Italy Purpose/Objective: Upper gastrointestinal tumours represent one of the most challenging scenarios for image-guided radiotherapy (IGRT), due to the combined effects of respiratory motion, organ deformation, and variable anatomical filling. Despite technological advances, clinical practice remains highly heterogeneous among centres. This national, multidisciplinary Delphi consensus, jointly promoted by the Italian Association of Radiotherapy and Clinical Oncology (AIRO), the Italian Association of Radiotherapy Technologists (AITRO), and the Italian Association of Medical Physicists (AIFM), was designed to harmonize IGRT implementation in upper-GI radiotherapy and to define shared, evidence-based recommendations. Material/Methods: A two-round modified Delphi process was conducted between May and August 2025 among twenty Italian experts (radiation oncologists, medical physicists, and RT technologists), each with ≥ 10 years of experience in upper-GI RT. Sixteen key questions were derived from a PRISMA-based literature review and organized into thematic areas: geometric uncertainties, immobilization, motion management, target and OAR delineation techniques, margin definition, and verification protocols. Experts rated their agreement on a five-point Likert scale; consensus was predefined as ≥ 75%. Items with partial agreement were refined and re-evaluated in Round 2. Results: All 20 experts completed both rounds. In Round 1, consensus was achieved on the main sources of geometric uncertainty: setup deviations (80% agreement), rotational errors (95%), respiratory motion (95%), and gastric filling variability (100%), and on the reliability of vacuum-bag and Body-fix systems (95% and 80%, respectively) for immobilization. Additional agreement was reached on the usefulness of integrating auto-contouring tools into the workflow for OAR delineation (75%) and on the feasibility of CTV- to-PTV margin reduction through daily setup verification, respiratory motion management, and proper patient preparation (90%). In Round 2, all 13 revised statements achieved consensus. Experts approved the integration of surface-guided RT (SGRT) (95%), the usefulness of intravenous contrast in planning CT to optimize target and OAR definition (100%), and the adoption of active respiratory control (breath-hold or gating) as effective motion- management strategy (90%). Fiducial markers were
Mini-Oral 3843 Multidisciplinary Delphi consensus on the use of image-guided radiotherapy for upper gastrointestinal tumours: an AIRO–AITRO–AIFM study Elena Galofaro 1 , Paola de Franco 2 , Filippo De Renzi 3 , Rita Alaimo 4 , Alessandra Arcelli 5,6 , Carlo Cavedon 7 , Patrizia Cornacchione 8 , Elena De Ponti 9 , Lia Famà 10 , Michele Fiore 11,12 , Nicola Iosca 13 , Valerio Pisoni 14 , Nicola Simoni 15 , Claudio Votta 8 , Marco Valenti 16 , Pierfrancesco Franco 17,18 , Domenico Genovesi 19 , Marco Lupattelli 4 , Gian Carlo Mattiucci 20 , Lidia Strigari 21 , Francesco Cellini 8 , Giovanna Mantello 1 , Francesca De Felice 22 , Giampaolo Montesi 23 , Rita Marina Niespolo 14 1 Department of Internal Medicine, Radiotherapy Unit, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy. 2 Radiotherapy Department, Ospedale Vito Fazzi, Lecce, Italy. 3 Radiotherapy Department, Ospedale San Martino, Belluno, Italy. 4 Radiation Oncology Unit, Azienda Ospedaliera di Perugia, Perugia, Italy. 5 Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy. 6 Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Bologna, Italy. 7 UOC Fisica Sanitaria, Azienda Ospedaliero - Universitaria Integrata Verona, Verona, Italy. 8 Department of Radiological, Radiotherapy and Hematological Sciences, Radiotherapy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. 9 Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy. 10 Department of Diagnostics – Medical Physics Unit, Ospedale Vito Fazzi, Lecce, Italy. 11 Research Unit of Radiation Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy. 12 Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitario Campus Biomedico di Roma, Rome, Italy. 13 Department of Allied Health Professions, Azienda Ospedaliero Universitaria Careggi, Florence, Italy. 14 Radiotherapy Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy. 15 Department of Oncohematology, Radiotherapy Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy. 16 Department of Radiological Sciences, Medical Physics Unit, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy. 17 Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy. 18 Department of Radiation Oncology, "Maggiore della Carità" University Hospital, Novara, Italy. 19 Department of Radiation Oncology, SS. Annunziata Hospital, “G. d’Annunzio” University, Chieti, Italy. 20 UOC Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy. 21 Medical Physics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. 22 Department of Radiological, Oncological and
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