Published online Aug 21, 2015. doi: 10.3748/wjg.v21.i31.9420
Peer-review started: October 1, 2014
First decision: November 26, 2014
Revised: December 21, 2014
Accepted: April 3, 2015
Article in press: April 3, 2015
Published online: August 21, 2015
Processing time: 323 Days and 19.9 Hours
AIM: To present a systematic review of techniques and clinical results.
METHODS: A systematic review of published literature was performed. Only studies reporting patient outcome after radiosurgery (single fraction) delivered with robotic devices [i.e., robotic radiosurgery (RRS)] have been analyzed.
RESULTS: A total of 96 patients from 5 studies were included. The studies are characterized by small series and different methods in terms of dose, target definition, combination with chemotherapy and/or standard fractionated radiotherapy and evaluation modalities. Preliminary results are positive in terms of tumor response (ORR = 56%) and local control of the tumor (crude rate of local progressions: 19.5%). Results for median overall survival (11.4 mo) seem comparable with the ones of prolonged chemoradiation (range: 8.6-13.0 mo). However, gastrointestinal toxicity seems to be the main limitation of RRS, especially at the duodenal level.
CONCLUSION: RRS allows for local treatment in a shortened time (1 fraction) compared to traditional treatments (about 1 mo), providing the possibility for an easy integration with systemic therapies. Preliminary results did not show any outcome differences compared to standard chemoradiation. Thus, further efforts to reduce gastrointestinal toxicity are strongly needed.
Core tip: Robotic radiosurgery, a type of stereotactic body radiotherapy, has been applied in a few experiences as an alternative to long course, conventional radiotherapy. As described in this systematic review, results suggest a good profile of efficacy. Its use in further trials appears justified to treat pancreatic lesions. Particular attention is needed to manage acute and late toxicity. Its potential is highly interesting for the opportunity of integration with chemotherapy and surgery.