Abstract Pancreatic cancer (PDAC) cells experience nutrient starvation in a poorly perfused tumor microenvironment. Metabolic dependencies that protect PDAC cells from detrimental oxidative stress in a nutrient-restricted niche represent as tumor-specific targets. While the role of mitochondria in supporting energy production and biosynthetic requirements of cells has been well investigated, their contribution to maintaining intracellular redox homeostasis when PDAC cells are exposed to nutrient deprivation is unknown. Our results demonstrate that cytosolic transport of citrate via SLC25A1 confers a survival advantage to PDAC cells by protecting them from ferroptosis, a well-established iron-dependent cell death mechanism, under nutrient-limited conditions. Employing selective SLC25A1 inhibitor or targeting mitochondrial OXPHOS dramatically reduced GPX4 expression and PDAC cell viability. Rescuing GPX4 expression with the products of both ACLY and ACO1-dependent pathways uncovered their critical role in conferring survival advantage under metabolic stress. Importantly, exogenous expression of GPX4 reversed redox imbalance and metabolic discordance resulting from the lack of SLC25A1 activity, indicating the requirement of citrate-induced GPX4 expression to support mitochondrial health and function. As observed with cultured cells under nutrient limitation, SLC25A1 function was revealed to be indispensable in pancreatic tumor microenvironment, and the reduced growth, due to the lack of SLC25A1 activity, was rescued with antioxidant NAC in preclinical models of PDAC. Lastly, SLC25A1 suppression was accompanied by elevated glutamine metabolism, and combination therapy with pharmacologic inhibitors of SLC25A1 and glutaminase inhibitor CB-839 dramatically suppressed tumor growth, highlighting this combinatorial approach as a potential therapeutic strategy in PDAC. Citation Format: Adam Kneebone, Kailey Lindaur, Ata Abbas, Joel Cassel, Sarah Graff, Caudia Rose Keating, Gerard Abood, Xianzhong Ding, William Small, Clodia Osipo, Wei Qiu, Curtis Tatsuoka, Simone Sidoli, Costas Andreas Lyssiotis, Joseph M. Salvino, Ali Vaziri-Gohar. Cytosolic transport of citrate protects nutrient-austere pancreatic cancer from ferroptosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 7325.

INTRODUCTION:In this systematic review and associated guidelines, the American Radium SocietyTM (ARS) thoracic and gastrointestinal oncology expert panels worked together to thoroughly evaluate current literature and provide treatment recommendations for best outcomes for resectable esophagus or gastroesophageal junction adenocarcinoma. To represent a diverse group representing all key specialties, thoracic and gastrointestinal radiation and medical oncologists, gastroenterologists, and thoracic surgeons were included in development of these consensus guidelines. METHODS:Using the Population, Intervention, Comparator, Outcome, Timing and Study Design framework, the evidence was assessed using Cochrane and PRISMA 2020 methodology. Eligible studies included randomized Phase II and III trials and retrospective subset analyses of randomized controlled trials published between January 1, 2019 and July 7, 2025 in the Ovid Medline database. These references were assessed via ARS Appropriate Use Criteria (AUC) methodology. RAND-UCLA consensus methodology was used to rate the appropriateness of various treatments. RESULTS:For patients with adenocarcinoma of the esophagus or gastroesophageal junction, the standard treatment approach has been trimodality therapy including chemotherapy, radiation, and surgery which is associated with significant long-term toxicity. Recent randomized controlled trials have compared perioperative chemotherapy to trimodality therapy affording the omission of radiotherapy for suitable patients and a resulting reduction in associated treatment-related toxicities. Recommendations for adjuvant and neoadjuvant therapies are provided, including chemotherapy, immunotherapy, targeted therapy and radiation therapy, and active surveillance after chemoradiation is also detailed. CONCLUSIONS:The updated 2026 ARS AUC for Operable Esophageal and Gastroesophageal Junction Adenocarcinoma is presented in this manuscript.

Gastric cancer requires optimal imaging for staging and surveillance. This document provides evidence-based recommendations for four scenarios: suspected gastric adenocarcinoma, staging of confirmed disease, posttreatment evaluation, and surveillance. For suspected gastric cancer, CT abdomen/pelvis with contrast and FDG-PET/CT are usually appropriate for initial staging. For confirmed disease staging, these modalities are usually appropriate for evaluating locoregional and distant metastases. For posttreatment evaluation, CT abdomen/pelvis with contrast is usually appropriate for treatment response assessment and recurrence detection, particularly in high-risk patients. FDG-PET/CT is usually appropriate for treatment response evaluation and distant recurrence detection. MRI with diffusion-weighted imaging may be appropriate when radiation exposure is a concern. For surveillance following curative surgical resection of gastric adenocarcinoma, CT abdomen and pelvis with contrast is usually appropriate as the primary imaging modality. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Realization of the full potential of external beam radiation therapy requires accurate targeting, which in turn depends on frequent imaging of patients immediately before or during treatment. These verification images may expose normal tissues surrounding the tumor to additional radiation. Although imaging doses are substantially lower than therapeutic doses, irradiated volumes are larger and repeated exposure carries a non-negligible risk of inducing second primary cancers in adjacent tissues and other late effects, particularly in younger patients with longer life expectancies. Cone beam computed tomography with kilovoltage systems mounted on linear accelerators is the modality used most widely for verification in image guided radiation therapy. In contrast to diagnostic radiology, where imaging parameters are adjusted routinely to optimize radiological protection for individual patients, radiation therapy departments often use vendors' supplied default protocols with limited optimization. As imaging is often performed at every fraction, there is considerable scope for further optimization of radiological protection. However, information about doses from cone beam computed tomography imaging, which is a prerequisite, is frequently not available. In diagnostic radiology, imaging dose management is supported by routine surveys of standardized dose indices and the use of diagnostic reference levels for benchmarking practice. This paper reviews the methods used in diagnostic radiology and considers how a similar approach might be applied to patient imaging doses in radiation therapy. It identifies appropriate dose quantities such as the Cone Beam Dose Index and wide beam computed tomography dose index that might be used for surveying and benchmarking imaging dose levels. It sets out actions that will be needed to initiate optimization to balance image quality requirements against patient doses and discusses the next phase of setting up radiation therapy specific dose reference levels. Establishing such reference levels can raise awareness, support systematic imaging dose reduction, and improve the safety and effectiveness of image guided radiation therapy.

Pelvic radiotherapy is commonly incorporated in the treatment of locally-advanced rectal cancer to reduce the risk of locoregional recurrence, but can be associated with substantial acute toxicity and long-term morbidity. However, treatment may be personalized for selective use of radiotherapy in a subset of patients identified to be at low to intermediate risk of locoregional recurrence following resection. This multi-specialty-led committee included gastrointestinal radiation and medical oncology, gastroenterology, radiology, and colorectal surgery. Using the Population, Intervention, Comparator, Outcome, Timing and Study Design (PICOTS) framework, evidence regarding treatment outcomes was assessed using Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Eligible studies included prospective and retrospective (n ≥ 50) studies published between 1/1/2005 - 6/24/2025 from Embase, Medline and PubMed databases. Study type and quality were assessed. Well-established RAND corportaion/University of California Los Angeles (RAND-UCLA) consensus methodology (modified Delphi) was used to rate the appropriateness of the treatment options. Of the 110 articles identified using the search strategy, 35 were selected that met all inclusion criteria. Of the 35 references used as evidence, 35 are categorized as therapeutic including 14 well-designed studies (Phase II randomized and Phase III), 12 moderately well-designed studies that account for most common biases (matched cohort and Phase II studies), 7 studies with design limitations (retrospective reviews), and 3 meta-analyses. Variant cases were developed as examples to illustrate practical applications of consensus recommendations for when RT can be safely omitted. A treatment algorithm is also provided to assist with treatment decisions when considering selective use of pelvic RT.

This literature-based systematic review and associated guidelines provide evidence-based paradigms for the management of locoregionally recurrent rectal cancer (LRRC). This multispecialty committee included gastrointestinal radiation and medical oncology, gastroenterology, radiology, and colorectal surgery. As is the standard, the previously described American Radium Society Appropriate Use Criteria methodology for this project was followed rigorously, with the Population, Intervention, Comparator, Outcome, Timing, and Study Design framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology to assess the evidence. RAND/University of California Los Angeles consensus methodology (modified Delphi) was used to rate the appropriateness of treatment options. Published between January 1, 2013, and July 16, 2025, 116 peer-reviewed trials provided the evidence: 10 were well-designed randomized phase 2/3 trials, 29 were moderately well designed trials that accounted for most common biases (matched cohort and phase 2), 76 trials had design limitations (retrospective), and one was a meta-analysis. Clinical cases were created as examples to illustrate current acceptable management of LRRC. Treatment and prognosis are influenced by prior therapy and the site(s) and extent of LRRC. The ability to achieve a margin-negative surgical resection is the ultimate determinant of survival and local control. Preoperative systemic therapy, radiation therapy, or a combination of the two can facilitate tumor downsizing and improve the likelihood of a margin-negative resection. An individualized multidisciplinary approach is required to ensure the best outcome. Although this review does not suggest a major alteration of current practice, it provides reassuring evidence of the importance of combined-modality therapy.

OBJECTIVES:To summarize current evidence for radiotherapy in the treatment of OA. The population, intervention, comparator, and outcome questions included: What is the role of LDRT for treatment of OA?; What are risks of LDRT?; and What are the optimal RT techniques for OA? METHODS:This multispecialty-led committee includes radiation oncologists, rheumatologists, orthopedic surgeons, and a patient advocate. Using the population, intervention, comparator, outcome, timing and study design (PICOTS) framework, evidence regarding treatment outcomes was assessed using Cochrane and PRISMA methodology. Eligible studies included prospective and retrospective (n≥50) studies published between January 1, 2010, and May 10, 2025, from Embase, Medline, and PubMed databases. Study type and quality were assessed. Well-established RAND-UCLA consensus methodology (modified Delphi) was used to rate the appropriateness of the treatment options. RESULTS:Of the 548 articles identified using the search strategy, 44 were selected for inclusion. Eight additional studies were identified through backward citation searching. Ten well-designed studies accounting for biases, 15 moderately well-designed studies accounting for the most common biases, 18 studies with design limitations, 8 supplemental studies not useful as primary evidence, and 1 meta-analysis were included. Additional studies were included to provide context and were not used to guide recommendations. The results of this analysis demonstrate that LDRT results in an overall treatment response rate of 60% to 90%, with significant clinical benefits including pain reduction, increased joint mobility, and improved quality of life. CONCLUSIONS:This systematic review and consensus guidelines for LDRT treatment of OA are based on current evidence. Further high-quality studies are warranted.

PURPOSE:Locally advanced endometrial cancers are heterogeneous and challenging to treat. Immunotherapy has transformed the treatment landscape. Given the complexity of tailoring adjuvant treatment recommendations, the multidisciplinary American Radium Society Gynecologic Cancer Panel created evidence-based guidelines for the management of locally advanced endometrial adenocarcinoma. METHODS AND MATERIALS:Search terms, key questions, and associated clinical case variants were formed by panel consensus. A review of the literature was conducted from January 1, 1996, to March 5, 2024, using the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines to systematically search the PubMed, Embase, and Web of Science databases to retrieve a comprehensive set of relevant articles. A well-established methodology (modified Delphi) was used by the expert panel to rate the appropriate use of procedures. RESULTS:Evidence for key questions in advanced-stage endometrial cancer was examined. Two rounds of voting were completed pertaining to the appropriateness of key management decisions for 4 clinical variants. Optimal adjuvant treatment is based on pathologic and molecular risk factors, and typically consists of combined modality therapy, with both chemotherapy and radiation, to minimize the risk of local and distant recurrence; there are no prospective data on optimal sequencing. Molecular data from PORTEC-3 highlights that adding chemotherapy to radiation is especially crucial for p53 abnormal tumors. Inclusion criteria for the NRG-GY018/RUBY trials can guide appropriateness of incorporating immunotherapy, which should be considered especially in mismatch repair-deficient (dMMR) patients. Radiation fields should be extended to include para-aortic lymph nodes in IIIC2 disease. Within pelvic radiation, intensity modulated radiation therapy is the preferred technique to mitigate toxicity as supported by prospective data. CONCLUSION:Selecting appropriate adjuvant therapies for advanced-stage endometrial cancer is nuanced. Further prospective studies harnessing molecular markers as therapeutic targets will help advance and optimize therapies for more personalized treatment of this complex disease.

Vaginal brachytherapy is a critical component in the treatment of gynecologic malignancies. Training in brachytherapy indications, procedural techniques, prescription dose/fractionation, treatment planning, and safety is essential to the safe and effective delivery of vaginal brachytherapy. This manuscript outlines the necessary knowledge and procedural skills for successful vaginal cylinder brachytherapy practice.

OBJECTIVES:To summarize recent high-quality trials and provide an update to the original 2022 American College of Radiology Appropriate Use Criteria for Treatment of Locoregional Gastric Adenocarcinoma. This multi-specialty-led committee included gastrointestinal radiation and medical oncology, gastroenterology, radiology, and surgical oncology. METHODS:Using the population, intervention, comparator, outcome, timing, and study design framework, the evidence was assessed using Cochrane and PRISMA 2020 methodology. Eligible studies included prospective Phase II/II trials and select retrospective studies published between 5/1/2020 and 8/1/2025 in the Embase, Medline, and Pubmed databases. Study type and quality were assessed. Well-established RAND-UCLA consensus methodology (modified Delphi) was used to rate the appropriateness of the treatment options. RESULTS:ARS AUC recommendations include adjuvant FLOT chemotherapy for localized gastric adenocarcinoma after neoadjuvant FLOT and surgery, poCT or perioperative chemoimmunotherapy for localized gastric adenocarcinoma, adjuvant chemotherapy +/- CRT for localized gastric adenocarcinoma that undergoes upfront surgery, and systemic therapy alone for localized gastric adenocarcinoma in a medically inoperable patient. CONCLUSIONS:This updated ARS AUC summary provides guidelines for the multimodality treatment of resectable gastric adenocarcinoma.

OBJECTIVES:Rates of locoregional recurrence and distant metastases are high following curative-intent resection for patients with localized pancreatic adenocarcinoma. Adjuvant therapies have been investigated with the intent to reduce the risk of recurrence and improve OS. The objective of this study is to update and summarize the current evidence for adjuvant therapy following surgical resection for nonmetastatic PDAC with a focus on high-level evidence and randomized controlled trials is provided. METHODS:This multispecialty-led committee included gastrointestinal radiation and medical oncology, gastroenterology, radiology, and surgical oncology. Using the population, intervention, comparator, outcome, timing and study design framework, evidence regarding treatment outcomes was assessed using Cochrane and PRISMA methodology. Eligible studies included prospective and retrospective (n≥25) studies published between January 1, 2013 and February 13, 2026, from Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Database of Systematic Review, and Scopus databases. Study type and quality were assessed. Well-established RAND/UCLA consensus methodology (modified Delphi) was used to rate the appropriateness of the treatment options. RESULTS:Of the 74 references used as evidence, 74 are categorized as therapeutic references. Study type and quality for the references were assessed, and included 31 well-designed studies (phase II randomized and phase III), 14 moderately well-designed studies that account for most common biases (matched cohort and phase II studies), 28 studies with design limitations (retrospective reviews), and 1 reference meta-analysis. CONCLUSIONS:This systematic review and guidelines provide up-to-date recommendations focusing on recent advancements for adjuvant treatment of resected PDAC using modern systemic therapy regimens and selective use of radiotherapy using modern techniques.

Since its inception in 2012, the Nuclear Medicine Global Initiative (NMGI) of the Society of Nuclear Medicine and Molecular Imaging has played an important role in addressing significant challenges in the field of nuclear medicine and molecular imaging. The first 3 projects were dedicated to standardizing pediatric nuclear medicine practices, addressing the global challenges of radionuclide access and availability, and assessing the educational and training initiatives on theranostics across the globe. These efforts aimed to advance human health, foster worldwide educational collaboration, and standardize procedural guidelines to enhance quality and safety in nuclear medicine practice. In its latest project, NMGI aimed to develop a unified nomenclature for systemic radionuclide therapy in nuclear medicine, addressing the diverse terminology currently used. An online survey was distributed to NMGI member organizations, drawing participation from various geographical locations and disciplines. The survey anonymously collected responses from physicians, physicists, scientists, radiopharmacists, radiopharmaceutical scientists, dosimetrists, technologists, and nurse managers, totaling 240 responses from 30 countries. Findings revealed a prevailing use of the term targeted radionuclide therapy for radionuclide therapy, with 52% of respondents expressing a preference for this term. In contrast, approximately 37% favored "radiopharmaceutical therapy," whereas 11% favored "molecular radionuclide therapy." Other key terms under the umbrella of targeted radionuclide therapy were also discussed to achieve a consensus on terminology. NMGI efforts to standardize terminology in this dynamic and fluid field should improve communication within the field, better reflect the technology used, enable comparison of results, and ultimately lead to improved patient outcomes.

Definitive chemoradiation has been the standard of care for locally advanced cervical cancer for almost 25 years, but despite advances in radiation therapy and brachytherapy techniques and approaches, survival outcomes generally remain poor. Two recent prospective randomized phase III trials, CALLA and Keynote A18, have explored the addition of concurrent and adjuvant immunotherapy to chemoradadiation for treatment intensification. Herein we explore how different high-volume insitutions have subsequently approached incorporation of immunotherapy into the management of locally advanced cervical cancer. Future studies and more long-term outcome data are warranted to better delineate which patients will derive the most benefit from first-line immunotherapy.

419 Background: A third of patients with biochemical recurrence after radiation (RT) have intraprostatic radiorecurrence (IPR) on PSMA PET/CT. Patients with IPR have worse metastasis-free survival - a surrogate for progression to lethal prostate cancer (PCa). We previously reported the results from our F-SHARP clinical trial that demonstrated salvage reirradiation using focal dose-escalated high dose rate (HDR) brachytherapy is safe and effective. Here, we examine the Decipher score to determine if it could be a tool to risk stratify patients with IPR. Methods: F-SHARP (NCT03312972) is a multi-institutional phase I/II trial of focal dose-escalated salvage HDR for IPR. Patients were recruited from 2017-2023 at 3 centers. Eligibility criteria included a history of localized PCa treated with any form of definitive RT and biopsy-proven IPR with no regional or distant metastasis. Of the 62 participants, 37 consented for the biomarker correlative study and 31 (50%) had sample data passing quality control for Decipher analysis (Veracyte, San Diego, CA). De-identified data from 146,940 patients tested (2016-2024) with the Decipher prostate genomic classifier were retrieved from the GRID registry (NCT02609269) and used to create a matched cohort based on NCCN risk at diagnosis. Univariable Cox proportional hazards models were used to compare oncologic, CTCAE v4.03 toxicity, and EPIC-26 hrQoL events by Decipher risk group. Results: The biomarker cohort had similar baseline characteristics to the overall trial cohort. 30% received ADT with initial RT (73% external beam, 27% LDR brachytherapy). At recurrence, 71% had high Decipher risk (median score 0.67) as compared to only 35% (median score 0.48) in the matched GRID cases (n=130,760). Median time from initial RT to enrollment in Decipher low (<0.45) was 16.9 years, compared to 8.0 and 7.4 years in the intermediate (0.45-0.6) and high (>0.6) score patients. Median follow up was 32.3 months. Decipher score was not associated with toxicity or quality of life post-HDR (all p>0.05). As depicted in the table, higher Decipher score was associated with an increased risk of biochemical progression-free survival (bFS; p=0.03), local recurrence-free survival (LRFS; p=0.04), and radiographic progression-free survival (rPFS; p=0.01). At 3 years, bPFS was 43% vs. 75%, LRFS was 58% vs. 100%, and rPFS was 42% vs. 100% for Decipher high vs. lower risk (<0.6). Conclusions: Salvage reirradiation is a growing indication for RT in PCa. This is the first use of genomic risk stratification in this setting. Nearly a third of patients with IPR have a lower Decipher risk score, and our data suggest especially favorable outcomes with salvage HDR. Future studies to determine how Decipher risk stratification can be used to tailor further treatment intensification with systemic therapy for those most at risk of reirradiation failure are warranted. Clinical trial information: NCT03312972 . Endpoint Hazard Ratio per 0.1 unit (95% CI) bPFS 1.70 (1.05-2.75) LRFS 2.30 (1.02-5.18) rPFS 2.47 (1.23-4.97)

Purpose This retrospective study evaluated the analgesic effects of low-dose radiation therapy (LDRT) for painful osteoarthritis. Methods and Materials We analyzed 69 patients who underwent LDRT for osteoarthritis between January and December 2023, treating 168 joints. Pain intensity was measured using a numeric rating scale for the total score (0-100) and the relevant score (0-10). Each phase of treatment was delivered as 3 Gy in 6 fractions (0.5 Gy per fraction) over 2 to 3 weeks. Assessments were conducted pretreatment (“pre-RT”), at the end of treatment (EOT), and at a 10-week follow-up (FU). The von Pannewitz score measured patient-assessed improvement. Results The mean pre-RT total pain score was 40.4, with a relevant pain score of 6.3. At EOT, scores decreased significantly to 26.0 and 4.0, respectively (p < .05 and p < .01). At FU, scores remained significantly low at 25.8 and 4.0, respectively (p < .05 and p < 0.1 compared with pre-RT). Eighty percent of joints showed significant pain improvement (von Pannewitz score 0-2) at EOT, with 72% maintaining this at FU. Thirty-three percent of joints received a second LDRT phase, demonstrating further pain reduction. Pain score improvements did not significantly differ across joint types (p = .29). Conclusions This modern American case series demonstrates significant and sustained pain relief with LDRT for osteoarthritis across various joint types. The findings suggest that LDRT is a promising noninvasive treatment option, with potential benefits of repeated courses in select patients. Further randomized controlled trials are needed to validate these observations.

OBJECTIVES:This practice parameter was revised collaboratively by the American College of Radiology (ACR) and American Radium Society (ARS). Stereotactic body radiation therapy (SBRT) precisely delivers higher dose(s) of radiation in 5 of fewer fractions, compared with conventional radiation. Given the complexity and technical nature of this treatment technique, practice parameters are needed to provide guidance to physicians and physicists. METHODS:This practice parameter was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website ( https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards ) by the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS. RESULTS:Workflow, qualifications/responsibilities of personnel, quality control, and treatment delivery/verification are reviewed. Notable elements of SBRT include image guidance, immobilization, and motion management, with the treatment planning goal of minimizing the volume of normal tissue exposed to medium and high dose levels and maximizing dose safely to the target. Specialized training is encouraged, as some technologies are not used in standard treatments. CONCLUSIONS:This practice parameter provides direction on key components recommended for SBRT and may be used as a guide to physicians and physicists wanting to provide this treatment to their patients.

BACKGROUND:Multimodality therapy incorporating a combination of cytoreductive surgery (CRS), intraperitoneal (IP) and systemic therapy continues to evolve for peritoneal carcinomatosis (PC) However, treatment and outcomes vary depending on tumor of origin. AIMS:To develop Appropriate Use Criteria (AUC) guidelines to facilitate treatment decision-making for patients with PC based on available evidence. MATERIALS AND METHODS:The American Radium Society (ARS) multidisciplinary expert panel performed a comprehensive systematic review. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) methodology was used. These studies were used to inform the expert panel, which then rated the appropriateness of various treatments in seven representative clinical scenarios through a well-established modified Delphi consensus methodology. RESULTS:Treatment of PC is often treated with a combination of CRS and IP ± systemic chemotherapy but specific recommendations exist for different tumor types and outcomes vary. DISCUSSION:Treatment of PC is complex and varies depending on origin of primary tumor and extent of disease. These AUC assist in patient and treatment selection for different clinical scenarios. CONCLUSION:A summary of recommendations is outlined to guide practitioners on the management of PC from different tumor origins.