S684
Clinical – Lower GI
ESTRO 2026
Switzerland. 10 Department of Radiation Oncology, Bern University Hospital, Bern, Switzerland
0.001). No grade ≥ 3 gastrointestinal toxicity was observed. Conclusion: Pre-treatment inflammatory biomarkers, particularly PLR and NLR, independently predict local tumor control and survival in BRPC and LAPC patients undergoing escalated-dose SBRT after neoadjuvant chemotherapy. The combined elevation of PLR and NLR identifies a high-risk subgroup prone to early local progression. Routine assessment of these markers may refine prognostic stratification, guide personalized treatment strategies, and improve multidisciplinary decision-making in pancreatic cancer management. References: 1. Salas, B.; Ferrera-Alayón, L.; Espinosa-López, A.; Vera-Rosas, A.; Salcedo, E.; Kannemann, A.; Alayon, A.; Chicas-Sett, R.; LLoret, M.; Lara, P.C. Dose-Escalated SBRT for Borderline and Locally Advanced Pancreatic Cancer. Feasibility, Safety and Preliminary Clinical Results of a Multicenter Study. Clin. Transl. Radiat. Oncol. 2024, 45, 100753.2.Ghanem, I.; Lora, D.; Herradón, N.; de Velasco, G.; Carretero-González, A.; Jiménez-Varas, M.; de Vázquez Parga, P.; Feliu, J. Neoadjuvant Chemotherapy with or without Radiotherapy versus Upfront Surgery for Resectable Pancreatic Adenocarcinoma: AMeta-Analysis of Randomized Clinical Trials. ESMO Open 2022, 7, 100485. Keywords: neoadjuvant, SBRT, escalate high dose, BRPC, LAPC
Purpose/Objective: Liver re-irradiation is an increasingly used treatment for hepatocellular carcinoma (HCC), liver metastases, and cholangiocarcinoma. Technological advances now enable precise delivery with improved organ sparing, but the practice remains heterogeneous and evidence is scarce. This study evaluated real-world pattern-of- care of liver re-irradiation among EORTC professionals. Material/Methods: A cross-sectional survey was distributed to through the EORTC network in May 2025, with a reminder sent in June 2025. The questionnaire was designed based on key controversies identified in the current literature and clinical practice related to liver re-irradiation in radiotherapy. Type 1 re-irradiation was defined as a new course of radiotherapy overlapping the previously irradiated volume, whereas type 2 referred to non- overlapping re-irradiation. Results: A total of 74 professionals from 28 countries completed the survey. Re-irradiation was performed for HCC by 35 professionals (52%), for liver metastases by 31 (57%), and for cholangiocarcinoma by 9 (19%) (Table 1). For HCC (n=35), type 2 re-irradiation was performed by 24% of respondents, typically delivered ≥ 6 months after the previous course (45%), and with a similar total dose (55%). For HCC, re- irradiation in Child Pugh (CP) B7 patients was evaluated on a case-by-case basis (76%), and half do not perform it in CP B8 (52%), with ≤ 2 simultaneous targets (64%). For liver metastases (n=31), type 2 re- irradiation predominated (36%), with dose reduction compared with the initial course (92%), and ≤ 2 simultaneous liver metastases (44%). In cholangiocarcinoma (n=9), type 2 re-irradiation was preferred by 33%, with reduced dose (67%), and ≤ 2 targets (56%). For HCC, liver metastases, and cholangiocarcinoma, practitioners (n=75) considered the previously delivered dose to the uninvolved liver (86%, 92%, and 67%, respectively) and emphasized the proximity of luminal organs and bile ducts as key limiting factors (59%, 64%, and 56%, respectively). The most important determinant for re- irradiation was the anatomical location of the new lesion (54%) (Figure 1). The recommended mean liver dose ranged from 10–15Gy for HCC (82%) and liver metastases (76%), decreasing to<10Gy for cholangiocarcinoma (44%). Liver constraints of V<15Gy >700–1000cc was applied by 55%, 64% and 89%. Preferred regimens were 41–50Gy in 5–8 fractions for HCC, and <30Gy in 5–8 fractions for liver metastases and cholangiocarcinoma.
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Real-World Pattern-of-Care Analysis of Liver Reirradiation Among European Organisation for Research and Treatment of Cancer Members (EORTC). Carolina De la Pinta 1,2 , Tiuri Kroese 3 , Antonella Cammarota 4 , Mauro Loi 5 , Lucjan Wyrwicz 6 , Marianne Gronlie 7,8 , Dora Correia 9,10
1 Radiation Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
2 Biomarkers and Therapeutic Targets Group, IRYCIS, Madrid, Spain. 3 Department of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland. 4 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. 5 Radiation Oncology, Universitaria Careggi, Università di Firenze, Firenze, Italy. 6 Radiation Oncology, Maria Sklodowska Curie National Cancer Research Institute, Warsaw, Poland. 7 Department of Oncology, Oslo University Hospital, Oslo, Norway. 8 Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 9 Department of Radiation Oncology, Cantonal Hospital Aarau, Aarau,
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