ESMO Gastrointestinal Oncology最新文献

{"title":"Systematic review and meta-analysis of studies assessing circulating tumor DNA kinetics in metastatic colorectal cancer","authors":"L.B. Callesen ,&nbsp;K.-L.G. Spindler","doi":"10.1016/j.esmogo.2026.100314","DOIUrl":"10.1016/j.esmogo.2026.100314","url":null,"abstract":"<div><h3>Background</h3><div>Circulating tumor DNA (ctDNA) kinetics have emerged as a promising biomarker for monitoring treatment response in metastatic colorectal cancer (mCRC). We carried out a systematic review and meta-analysis to comprehensively assess the prognostic value of ctDNA kinetics during palliative systemic therapy, aiming to consolidate the current evidence and clarify its potential role in clinical practice.</div></div><div><h3>Materials and methods</h3><div>PubMed, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials were searched (last search 12 September 2025). Eligible studies assessed the association between ctDNA kinetics and outcomes in patients with mCRC receiving systemic palliative treatment. Meta-analyses were carried out to evaluate associations with survival outcomes.</div></div><div><h3>Results</h3><div>A total of 64 studies, including data from &gt;2760 patients with mCRC receiving palliative systemic therapy, met the eligibility criteria. Across studies, unfavorable ctDNA kinetics were consistently associated with poorer outcomes, including shorter overall survival (OS) [pooled hazard ratio (HR) 2.6, 95% confidence interval (CI) 2.2-3.2, <em>n</em> = 1086] and progression-free survival (PFS) (pooled HR 2.7, 95% CI 2.4-3.1, <em>n</em> = 1093).</div></div><div><h3>Conclusion</h3><div>ctDNA kinetics during palliative systemic therapy have strong prognostic value in mCRC. However, clinical implementation is hampered by methodological heterogeneity, particularly the use of study-specific ctDNA markers and non-validated cut-offs. Standardized and externally validated approaches are needed to support clinical implementation.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100314"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and molecular characteristics of early-onset pancreatic and biliary cancers","authors":"C. Smolenschi ,&nbsp;M. Rémond ,&nbsp;M. Valéry ,&nbsp;M. Brugel ,&nbsp;M. Ducreux ,&nbsp;A. Turpin ,&nbsp;A. Boilève","doi":"10.1016/j.esmogo.2025.100271","DOIUrl":"10.1016/j.esmogo.2025.100271","url":null,"abstract":"<div><div>Biliary tract cancer and pancreatic cancer are aggressive malignancies, typically diagnosed in patients &gt;50 years of age. Lately, &lt;50 years of age has been rising, presenting unique challenges and clinical features that distinguish them from late-onset cases.</div><div>Here, we review the clinical, biological, and molecular characteristics of early-onset biliary tract cancer and pancreatic cancer and compare them with their late-onset counterparts. We also examine treatment patterns, efficacy, and the potential role of targeted therapies, as well as the potential psychological and social effects on younger patients, with particular emphasis on fertility. We therefore offer insights into the unique challenges and therapeutic strategies in managing early-onset disease.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100271"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline and dynamic cytokines as biomarkers for immune checkpoint and anti-VEGF therapy in advanced hepatocellular carcinoma","authors":"H.C. Wilbur ,&nbsp;L.X. Zhao ,&nbsp;M. Nakazawa ,&nbsp;C. Kao ,&nbsp;J.D. Gordan ,&nbsp;T.P. Gade ,&nbsp;L. Cope ,&nbsp;L.T. Kagohara ,&nbsp;D. Zabransky ,&nbsp;W.J. Ho ,&nbsp;M. Baretti ,&nbsp;M. Yarchoan","doi":"10.1016/j.esmogo.2025.100273","DOIUrl":"10.1016/j.esmogo.2025.100273","url":null,"abstract":"<div><h3>Background</h3><div>Immune checkpoint inhibitors (ICIs), or the combination of ICIs and vascular endothelial growth factor (VEGF) inhibitors, are the preferred treatments for advanced hepatocellular carcinoma (HCC). However, the immunomodulatory effects of anti-VEGF therapy in HCC remain poorly understood. Predictive biomarkers are needed to guide therapy selection.</div></div><div><h3>Patients and methods</h3><div>We prospectively analyzed circulating cytokines in patients with advanced HCC receiving ICIs with or without anti-VEGF inhibitor therapy as standard of care. Serum samples were collected at baseline and ∼2 months after treatment initiation. A 32-cytokine Luminex panel was used to assess systemic immune changes. We examined associations between treatment group, cytokine dynamics, and clinical outcomes.</div></div><div><h3>Results</h3><div>Among 56 enrolled patients, 35 patients were treated with ICIs only (ICI-only), and 21 patients were treated with ICIs plus the VEGF inhibitor bevacizumab (ICI + Bev). Demographic characteristics and treatment outcomes were generally balanced between the two groups. As compared with ICI-only, patients receiving ICI + Bev exhibited significantly reduced fold changes in multiple cytokines on treatment, including sCD40L, macrophage inflammatory protein-1β (MIP-1β), monokine induced by interferon-γ (MIG), and interleukin (IL)-1Ra, of which above-median circulating baseline levels of MIP-1β were associated with inferior clinical outcomes. In addition, patients with above-median circulating levels of IL-6 and IL-12p40 at baseline had longer progression-free survival with ICI + Bev versus ICI-only. Treatment-associated reductions in IL-1Ra, IL-8, IL-18, and VEGF-A were associated with favorable clinical outcomes.</div></div><div><h3>Conclusions</h3><div>In a highly exploratory analysis, myeloid-inflammatory signatures at baseline and treatment-associated reductions in key myeloid cytokines may identify patients most likely to benefit from adding Bev to ICI. Prospective validation of these markers in independent cohorts is warranted.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100273"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-system outcomes after adopting yttrium-90 radioembolization with personalized dosimetry as the primary treatment approach for unresectable, solitary hepatocellular carcinoma","authors":"A. Zamani ,&nbsp;K. Núñez ,&nbsp;T. Sandow ,&nbsp;J. Gimenez ,&nbsp;A. Cohen ,&nbsp;P. Thevenot","doi":"10.1016/j.esmogo.2026.100309","DOIUrl":"10.1016/j.esmogo.2026.100309","url":null,"abstract":"<div><h3>Background</h3><div>Yittrium-90 (⁹⁰Y) radioembolization has emerged as a secondary treatment option for early- to intermediate-stage hepatocellular carcinoma (HCC) in the Barcelona Clinic Liver Cancer (BCLC) Staging and Treatment Algorithm. Several trials have recently shown that ⁹⁰Y is a safe and effective primary treatment option for BCLC stages A and B. In this study, the outcomes for three treatment centers within a single health system with experience utilizing ⁹⁰Y as a definitive treatment option for early-stage HCC (BCLC-A) were analyzed in the context of results reported by the DOSISPHERE-01 and TARGET clinical trials.</div></div><div><h3>Materials and methods</h3><div>The cohort was derived from multiple treatment centers within a single health system that utilized ⁹⁰Y as the primary option for BCLC-A solitary, unresectable HCC &gt;3 cm and as a secondary option for HCC &lt;3 cm, both with an Eastern Cooperative Oncology Group score of 0-1 and Child–Pugh A5-B9 (<em>n</em> = 171, 2018-2024). The study outcomes included first-cycle objective response (OR) and complete response (CR) rates, target time to retreatment (tTTR), time to BCLC-C progression, progression-free survival (PFS), and overall survival (OS).</div></div><div><h3>Results</h3><div>Patients were enrolled between 2018 and 2024 (<em>n</em> = 171). OS rates at 1 and 3 years were 94% and 73%, with 1- and 3-year PFS rates of 89% and 61%, respectively. Response to first-cycle ⁹⁰Y could be assessed in 166 patients. The overall OR rate was 98% (163/166), with 71% (118/166) achieving a target CR. Patients who obtained a target CR had reduced progression rates at 1 year (2% versus 16%) and 3 years (21% versus 62%) compared with incomplete responders. The median tTTR in patients who achieved a target CR was 48 months, with 1- and 2-year retreatment rates of 9% and 24%, respectively.</div></div><div><h3>Conclusion</h3><div>First-cycle ⁹⁰Y radioembolization with personalized dosimetry is an effective treatment option for early-stage, solitary HCC that yields high, sustained response rates.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100309"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of established and new developments in local therapies for liver cancer","authors":"P. Seda ,&nbsp;R. Abbey ,&nbsp;L. Peng ,&nbsp;I. Ezeaku ,&nbsp;S.T. Laroia ,&nbsp;H. Aziz","doi":"10.1016/j.esmogo.2025.100283","DOIUrl":"10.1016/j.esmogo.2025.100283","url":null,"abstract":"<div><div>Liver cancer, especially hepatocellular carcinoma (HCC), which accounts for ∼75%-85% of primary liver cancers, remains a major global health challenge. Because of its high incidence, late diagnosis, and limited curative options, local therapies have become increasingly popular for the multidisciplinary management of HCC, especially in early and intermediate Barcelona Clinic Liver Cancer stages or in medically inoperable patients. This review examines a landscape of local treatment modalities for HCC encompassing radiofrequency ablation, microwave ablation, cryoablation, irreversible electroporation, histotripsy, transarterial chemoembolization, transarterial radioembolization, and stereotactic body radiotherapy. We also highlight their respective advantages and disadvantages, compare their survival outcomes, and identify current gaps in the literature, including the need for further comparisons between safety profiles and efficacy, and the growing landscape that is using different local therapies in a sequential or combinatorial fashion. Emphasis is placed on treatment decisions tailored to tumor burden, liver function, and patient-specific considerations. Expanding access to advanced local therapies in resource-limited settings remains a global priority.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100283"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preference versus protocol: oncology clinicians’ perspectives on central venous access for administration of chemotherapy in pancreatic cancer","authors":"M.U.J.E. Graus ,&nbsp;R.A.L. Willems ,&nbsp;N.C. Biesma ,&nbsp;A.J. de Wilde ,&nbsp;F.W.P.J. van den Berkmortel ,&nbsp;S.A.W. Bouwense ,&nbsp;G.A. Cirkel ,&nbsp;M.Y.V. Homs ,&nbsp;E. Jellema-Betten ,&nbsp;N. Pepels-Aarts ,&nbsp;H.C. van Santvoort ,&nbsp;E.C.J. van Vliet ,&nbsp;M.L. Wumkes ,&nbsp;J.W. Wilmink ,&nbsp;I.H.J.T. de Hingh ,&nbsp;L.B.J. Valkenburg-van Iersel ,&nbsp;J. de Vos-Geelen ,&nbsp;Dutch Pancreatic Cancer Group","doi":"10.1016/j.esmogo.2026.100311","DOIUrl":"10.1016/j.esmogo.2026.100311","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic cancer treatment significantly impacts patients’ quality of life, making both safety and patient preference key considerations. Central venous access devices (CVADs) are indispensable for chemotherapy administration in pancreatic cancer, yet device selection varies widely. This study explored which CVADs oncology specialists use in pancreatic cancer care, focusing on the basis for their recommendations.</div></div><div><h3>Materials and methods</h3><div>A nationwide expert survey was distributed among Dutch medical oncologists and nurse specialists involved in pancreatic cancer care via the Dutch Pancreatic Cancer Group, the Dutch Association for Medical Oncology, the Dutch association for nurses, and the study committee’s network.</div></div><div><h3>Results</h3><div>Ninety-one clinicians responded. Most (88%) had access to both port-a-caths (PORTs) and peripherally inserted central catheters (PICCs), while 12% could only offer one device. Decision-making autonomy varied: 53% reported full autonomy, while others followed hospital-wide preferences (39%) or guidelines (9%). Even within these subgroups, preferred CVAD varied greatly. Although 60% listed patient preference among the top five influential factors, only 28% incorporated patients in that decision. Logistical constraints were key barriers influencing device choice.</div></div><div><h3>Conclusion</h3><div>Substantial variability exists in CVAD selection, availability, and clinician autonomy in pancreatic cancer care. While evidence supports PORTs as the safer option, PICCs remain widely used in daily practice. This discrepancy appears driven by disease-specific and logistical factors, including poor prognosis and uncertainty regarding treatment tolerance. Addressing real-world barriers through improved access to PORTs, clearer guideline recommendations, and enhanced patient counseling may help align clinical practice with evidence and ensure high-quality care for patients receiving chemotherapy.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100311"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ESMO podcast on upper GI cancers: highlights in hepatocellular carcinoma and pancreatic cancer from ESMO 2025","authors":"J. Dekervel ,&nbsp;A. Vogel ,&nbsp;E. O’Reilly","doi":"10.1016/j.esmogo.2025.100277","DOIUrl":"10.1016/j.esmogo.2025.100277","url":null,"abstract":"","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100277"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-related quality of life in biliary tract cancer clinical trials. The current state and future directions","authors":"L. Cavka ,&nbsp;J. Edeline ,&nbsp;A. Lamarca","doi":"10.1016/j.esmogo.2026.100301","DOIUrl":"10.1016/j.esmogo.2026.100301","url":null,"abstract":"<div><h3>Background</h3><div>Patients with biliary tract cancers (BTCs) often experience a decline in health-related quality of life (HRQoL). Patient-reported outcome measures (PROMs), usually collected through HRQoL questionnaires, offer a standardized approach to capturing the patient’s perspective. This study aimed to provide a comprehensive analysis of HRQoL in BTC clinical trials.</div></div><div><h3>Design</h3><div>After database screening, the 30 most impactful clinical trials in BTC were identified for evaluation of HRQoL reporting and analysis. The primary objective was to determine the proportion of trials that included HRQoL assessment. Secondary objectives were to examine different aspects of HRQoL analysis and to assess the robustness of reporting using the recently developed European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) HRQoL checklist.</div></div><div><h3>Results</h3><div>Fifteen trials (50%) included HRQoL in their design, with published results available for 14. The most frequent HRQoL outcome was stability (i.e. neither improvement nor deterioration). The median ESMO-MCBS HRQoL checklist score was 11 (interquartile range 9.00-11.75).</div></div><div><h3>Conclusions</h3><div>HRQoL remains only partially addressed in BTC clinical trials. Tools such as the ESMO HRQoL checklist and electronic PROMs may strengthen the assessment and highlight the importance of HRQoL in both clinical trials and routine practice.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100301"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathologic correlates of claudin 18.2 expression in esophagogastric cancer at multiple expression levels","authors":"C.H. Maeng ,&nbsp;A. Alkashash ,&nbsp;A. Sy ,&nbsp;H. Barnes ,&nbsp;S. Bannon ,&nbsp;C. Simms ,&nbsp;M.R. Strickland ,&nbsp;J.N. Glickman ,&nbsp;S.J. Klempner","doi":"10.1016/j.esmogo.2025.100278","DOIUrl":"10.1016/j.esmogo.2025.100278","url":null,"abstract":"<div><h3>Background</h3><div>Claudin-18 isoform 2 (CLDN18.2) is a validated therapeutic target in gastric cancer (GC) and gastroesophageal junction cancer (GEJ). The approved antibody zolbetuximab requires higher expression levels (≥75% of tumor cells with 2-3+ membranous staining), yet broader thresholds are increasingly explored. Data on clinicopathologic correlates and biomarker overlap at lower cut-offs remain limited.</div></div><div><h3>Patients and methods</h3><div>We retrospectively analyzed patients with esophageal cancer (EC), GEJ, or GC who underwent CLDN18.2 immunohistochemistry at a single high-volume center (2023-2025). CLDN18.2 positivity was defined using three thresholds: (i) stringent (<em>75% threshold</em>: ≥75% of tumor cells with 2-3+ staining); (ii) broader (<em>H-score 25</em>; ≥1+ intensity in ≥25% of cells); and (iii) the lowest (<em>H-score 10</em>; ≥1+ intensity in ≥10% of cells). Associations between CLDN18.2 and clinicopathologic variables, including histology and standard biomarkers [human epidermal growth factor receptor 2 (HER2), programmed death-ligand 1 (PD-L1), and mismatch repair (MMR)], were assessed.</div></div><div><h3>Results</h3><div>In total, 149 patients were included: 43 EC (28.9%), 46 GEJ (30.9%), and 60 GC (40.3%). CLDN18.2 positivity rates were 48.3%, 71.1%, and 73.8% at the <em>75%</em>, <em>H-score 25</em>, and <em>H-score 10</em> thresholds, respectively. CLDN18.2 positivity significantly correlated with tumor location, highest in GC and followed by GEJ and EC across thresholds. At the lowest cut-off, positivity was 85.0% in GC, 69.6% in GEJ, and 62.8% in EC (<em>P</em> = 0.030). Histological subtypes were also associated across thresholds: poorly cohesive carcinoma (PCC) demonstrated significantly higher positivity than non-PCC. No significant associations were found with HER2, PD-L1 combined positive score, or MMR. Triple positivity for CLDN18.2, HER2, and PD-L1 was rare (≤5.5%).</div></div><div><h3>Conclusion</h3><div>CLDN18.2 expression in upper gastrointestinal cancers was significantly associated with gastric origin and PCC histology, independent of HER2 and PD-L1 status. Broadening the threshold for positivity identified nearly three-quarters of patients as CLDN18.2 positive, underscoring the impact of selection cut points on trial eligibility. These findings highlight the potential to expand patient access to CLDN18.2-targeted therapies using lower thresholds.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100278"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of stereotactic body radiotherapy in the management of hepatocellular carcinoma with macroscopic vascular invasion: a narrative review","authors":"I.J. Gerard ,&nbsp;A.M. Glynn ,&nbsp;M.D. Faye ,&nbsp;M. Yan ,&nbsp;A. Mesci ,&nbsp;T.K. Kim ,&nbsp;R. Vanner ,&nbsp;L.A. Dawson","doi":"10.1016/j.esmogo.2025.100298","DOIUrl":"10.1016/j.esmogo.2025.100298","url":null,"abstract":"<div><div>Hepatocellular carcinoma (HCC) is the most common primary liver cancer, with a rising global incidence. Prognosis in HCC remains poor, particularly in patients presenting with macrovascular invasion (MVI), which is associated with high rates of hepatic decompensation, diffuse disease progression, and a median survival of only 2-5 months without treatment. Management of HCC with MVI is complex, requiring multidisciplinary and multimodality approaches. While surgery and transplantation may be considered in select cases, systemic therapy with immunotherapy-based regimens currently represents standard of care. Limitations due to complications with MVI often makes optimal treatment challenging. Advances in modern radiotherapy, particularly stereotactic body radiotherapy (SBRT), have established it as a safe and effective local therapy capable of delivering ablative doses while sparing normal liver tissue. Retrospective series and prospective trials have demonstrated that SBRT provides high local control rates, objective response rates exceeding 50%, and survival benefits when combined with systemic or locoregional therapies alone. SBRT has also shown promise in improving liver function and palliating symptoms in patients with poor hepatic reserve. Emerging evidence suggests synergistic effects when combined with immunotherapy or transarterial therapies, with ongoing studies poised to clarify its role in modern treatment paradigms. Collectively, data support the use of SBRT as a crucial tool in the multidisciplinary management of HCC with MVI, offering durable local control, symptom relief, and the potential to enhance systemic therapy efficacy.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100298"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}