RCR 2019 – Combining precision radiotherapy with systemic treatment in biliary and pancreatic cancers

  • Jo Whelan
  • Oncology Conference Roundups
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.


  • We are moving towards precision regimens for biliary, pancreatic, and colorectal cancers: these may combine advanced radiotherapy with systemic treatment.
  • A better understanding of disease biology is needed to inform patient selection.
  • A proposed trial will provide the opportunity to use stereotactic body radiation therapy (SBRT).

Why this matters

  • Prognosis in these cancers remains poor.

Metastases are the real killer in GI malignancies, Professor Maria Hawkins (University College London) reminded RCR19 delegates. Oligometastatic disease is therefore a key arena for progress.

Local control does not necessarily improve progression-free survival. New regimens will therefore include both precision radiotherapy and systemic treatment where appropriate, tailored to individual patient characteristics.

  • Integrating precision radiotherapy with immuno-oncology – understanding when and how and in whom to combine these approaches is a key goal.
  • SBRT should be more widely used, but not all patients can benefit. Prospective data are needed to aid patient selection.

Tumour biology predicts outcome better than clinical characteristics. A proposed new trial – OLIGO1 – will include biological characterisation of oligometastatic disease and provide an opportunity for greater use of SBRT in this setting; usage is currently very low.

The trial will compare standard of care + local control (surgery or SBRT) versus standard of care alone in oesophagogastric, pancreatic, neuroendocrine, and primary hepatobiliary cancer, with a separate master protocol for each.

Advances in physical science, imaging, informatics, artificial intelligence, and cancer biology can all be harnessed to achieve precision treatment. Multidisciplinary working – greater interaction between radiologists, surgeons and medical oncologists – will be vital.