Abstract Background Patients with oligometastatic disease can potentially be cured by using an ablative therapy for all active lesions. Stereotactic body radiotherapy (SBRT) is a non-invasive treatment option that lately proved to be as effective and safe as surgery in treating lung metastases (LM). However, it is not clear which patients benefit most and what are the most suitable fractionation regimens. The aim of this study was to analyze treatment outcomes after single fraction radiosurgery (SFRS) and fractionated SBRT (fSBRT) in patients with lung oligometastases and identify prognostic clinical features for better survival outcomes. Methods Fifty-two patients with 94 LM treated with SFRS or fSBRT between 2010 and 2016 were analyzed. The characteristics of primary tumor, LM, treatment, toxicity profiles and outcomes were assessed. Kaplan-Meier and Cox regression analyses were used for estimation of local control (LC), overall survival (OS) and progression-free survival. Results Ninety-four LM in 52 patients were treated using SFRS/fSBRT with a median of 2 lesions per patient (range: 1–5). The median planning target volume (PTV)-encompassing dose for SFRS was 24 Gy (range: 17–26) compared to 45 Gy (range: 20–60) in 2–12 fractions with fSBRT. The median follow-up time was 21 months (range: 3–68). LC rates at 1 and 2 years for SFSR vs. fSBRT were 89 and 83% vs. 75 and 59%, respectively (p = 0.026). LM treated with SFSR were significantly smaller (p = 0.001). The 1 and 2-year OS rates for all patients were 84 and 71%, respectively. In univariate analysis treatment with SFRS, an interval of ≥12 months between diagnosis of LM and treatment, non-colorectal cancer histology and BED < 100 Gy were significantly associated with better LC. However, none of these parameters remained significant in the multivariate Cox regression model. OS was significantly better in patients with negative lymph nodes (N0), Karnofsky performance status (KPS) > 70% and time to first metastasis ≥12 months. There was no grade 3 acute or late toxicity. Conclusions Longer time to first metastasis, good KPS and N0 predicted better OS. Good LC and low toxicity rates were achieved after short SBRT schedules.

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The QUIRO study aimed to establish a secure level of quality and innovation in radiation oncology. Over 6 years, 27 specific surveys were conducted at 24 radiooncological departments. In all, 36 renowned experts from the field of radiation oncology (mostly head physicians and full professors) supported the realization of the study.

Image-guided diagnostic and therapeutic procedures are related to, or performed under, some kind of imaging. Such imaging may be direct inspection (as in open surgery) or indirect inspection as in endoscopy or laparoscopy. Common to all these techniques is the transformation of optical and visible information to a monitor or the eye of the operator. Image-guided therapy (IGT) differs by using processed imaging data acquired before, during and after a wide range of different imaging techniques. This means that the planning, performing and monitoring, as well as the control of the therapeutic procedure, are based and dependent on the "virtual reality" provided by imaging investigations. Since most of such imaging involves radiology in the broadest sense, there is a need to characterise IGT in more detail. In this paper, the technical, medico-legal and medico-political issues will be discussed. The focus will be put on state-of-the-art imaging, technical developments, methodological and legal requisites concerning radiation protection and licensing, speciality-specific limitations and crossing specialty borders, definition of technical and quality standards, and finally to the issue of awareness of IGT within the medical and public community. The specialty-specific knowledge should confer radiologists with a significant role in the overall responsibility for the imaging-related processes in various non-radiological specialties. These processes may encompass purchase, servicing, quality management, radiation protection and documentation, also taking responsibility for the definition and compliance with the legal requirements regarding all radiological imaging performed by non-radiologists.

Autoren T. Seufferlein1, M. Porzner1, T. Becker2, V. Budach3, G. Ceyhan4, I. Esposito5, R. Fietkau6, M. Follmann7, H. Friess4, P. Galle8, M. Geißler9, M. Glanemann10, T. Gress11, V. Heinemann12, W. Hohenberger13, U. Hopt14, J. Izbicki15, E. Klar16, J. Kleeff4, I. Kopp17, F. Kullmann18, T. Langer7, J. Langrehr19, M. Lerch20, M. Löhr21, J. Lüttges22, M. Lutz23, J. Mayerle20, P. Michl11, P. Möller24, M. Molls25, M. Münter26, M. Nothacker27, H. Oettle28, S. Post29, A. ReinacherSchick30, C. Röcken31, E. Roeb32, H. Saeger33, R. Schmid34, W. Schmiegel35, M. Schoenberg36, J. Siveke34, M. Stuschke37, A. Tannapfel38, W. Uhl39, S. Unverzagt40, B. van Oorschot41, Y. Vashist15, J. Werner42, E. Yekebas43 Institute Die Institutsangaben sind am Ende des Beitrags gelistet.

Autoren T. Seufferlein1, M. Porzner1, T. Becker2, V. Budach3, G. Ceyhan4, I. Esposito5, R. Fietkau6, M. Follmann7, H. Friess4, P. Galle8, M. Geißler9, M. Glanemann10, T. Gress11, V. Heinemann12, W. Hohenberger13, U. Hopt14, J. Izbicki15, E. Klar16, J. Kleeff4, I. Kopp17, F. Kullmann18, T. Langer7, J. Langrehr19, M. Lerch20, M. Löhr21, J. Lüttges22, M. Lutz23, J. Mayerle20, P. Michl11, P. Möller24, M. Molls25, M. Münter26, M. Nothacker27, H. Oettle28, S. Post29, A. ReinacherSchick30, C. Röcken31, E. Roeb32, H. Saeger33, R. Schmid34, W. Schmiegel35, M. Schoenberg36, J. Siveke34, M. Stuschke37, A. Tannapfel38, W. Uhl39, S. Unverzagt40, B. van Oorschot41, Y. Vashist15, J. Werner42, E. Yekebas43 Institute Die Institutsangaben sind am Ende des Beitrags gelistet.

There is an increasing body of evidence showing that patients with resectable pancreatic cancer might benefit from adjuvant therapy. Based on phase III trials, potential options for adjuvant treatment are chemotherapy alone or a multimodal approach involving radiotherapy. Available data are heterogeneous and have been discussed controversially. Hitherto, a worldwide standard of care has not yet been established. Adequate patient selection might be the key element for a tailored adjuvant treatment. Clinical research currently focusses on gemcitabine alone or in combination, and some molecular biologic approaches with epidermal growth factor receptor monoclonal antibodies (EGFR-MoABs) and anti-angiogenic drugs. Recent advances in radiooncology offer better dose conformality and reduced morbidities. Currently, the co-operative Radiotherapy and Gastrointestinal Groups have launched a multicentric European Organization for Research and Treatment of Cancer (EORTC) trial investigating the impact of radiotherapy in combination with gemcitabine in R0-resected pancreatic head cancer.