What if any, is your radiation approach to treating hepatic metastases abutting/invading luminal GI structures?

My approach to hepatic metastases abutting luminal GI structures is fundamentally conservative. When liver metastases abut or threaten invasion of the stomach, duodenum, or bowel, I do not treat this as a classic SBRT scenario. The priority shifts from local ablation to durable local control and pre...

If treating with radiation therapy in this context, I would recommend using a hypofractionated approach (e.g., 45-70 Gy in 15 fractions; most frequently 45 Gy due to the ability to meet constraints), compromising coverage as appropriate to spare normal structures, given the luminal structure sparing...

There is a difference between abutting and invading, and I would seek to clarify this, either by MRI or endoscopically. If abutting, I would proceed to second-line therapy for systemic control, and recommend hepatic resection as the adjacent stomach will always be an issue for radiation. (This would...