This guideline provides evidence-based recommendations addressing the indications for radiation therapy (RT) for gastric cancer in a variety of clinical settings, ranging from patients with resectable locoregional disease to metastatic and symptomatic disease.

Breast cancer is the leading cause of cancer in women in Spain and its annual incidence is rapidly increasing. As a result of the screening programs in place, nearly 90% of breast cancer cases are detected in early and potentially curable stages. In recent years, locoregional and systemic therapies have increasingly been directed by new diagnostic tools that have improved the balance between toxicity and clinical benefit. New therapeutic strategies, such as immunotherapy, targeted drugs, and antibody-drug conjugates, have also improved outcomes in some patient subgroups. This clinical practice guideline for early-stage breast cancer (updated in 2025) is based on a systematic review of relevant studies and on the consensus of experts from the Spanish Breast Cancer Research Group (GEICAM), Spanish Collaborative Group for the Study, Treatment and Other Experimental Strategies in Solid Tumors (SOLTI), and Spanish Society of Medical Oncology (SEOM).

Herein are presented the update of the recommendations from the Société française de radiothérapie oncologique (the French society for radiation oncology) regarding the indications and methods of lung cancer radiotherapy. The recommendations for delineation of the target volumes and organs at risk are detailed.

This article reports on the updated recommendations of the Société française de radiothérapie oncologique on external radiotherapy for prostate cancer. External radiotherapy is aimed for all localized prostate cancers, and more recently at oligometastatic prostate cancers. Irradiation techniques are detailed according to different risk levels. Prostate image-guided intensity-modulated radiotherapy is the recommended technique for these cancers. A total dose of 74 to 80Gy is recommended for standard fractionation (delivered in 2Gy fractions). Moderate hypofractionation (delivering a total dose of 60Gy at a rate of 3Gy per fraction over 4weeks) in the prostate has become a therapeutic standard. Extreme hypofractionation (delivering 35 to 40Gy in five fractions) to treat the prostate without pelvis, using a technique under stereotactic conditions, can be considered a recent standard in favourable and intermediate risk disease. The postoperative irradiation technique, mainly indicated in cases of biochemical recurrence and lymph node involvement, is described in detail. Recommendations concerning contouring and dosimetry are also provided.

This manuscript presents a systematic review and expert consensus from oncology and surgery on the management of metastatic gastric cancer. A literature search was conducted in PubMed and Google Scholar, selecting 28 relevant studies (21 clinical trials and 7 systematic reviews), along with international guidelines. The objective was to assess the role of surgery and locoregional therapies in patients with peritoneal, hepatic, pulmonary, or nodal metastases, and to establish multidisciplinary recommendations. Cytoreductive surgery associated to HIPEC may offer benefits in selected patients with limited peritoneal carcinomatosis (Peritoneal Carcinomatosis Index ≤ 6), an absence of distant metastasis, an adequate response to systemic chemotherapy and an ECOG performance status of 0-1. Resection of non-peritoneal metastases may also be considered in specific contexts. Prospective clinical trials are required to confirm these findings and define optimal selection criteria.

Salivary gland tumours are relatively common among rare tumors and encompass both benign (mostly) and malignant entities (not to be initially misdiagnosed). Early diagnosis and appropriate management are crucial determinants of prognosis. The treatment of malignant tumours is guided by their wide histological diversity and grading, each requiring specific therapeutic strategies. Surgical resection remains the standard of care, with ipsilateral neck dissection recommended for intermediate- or high-grade malignancies. Postoperative radiotherapy is indicated for high-grade tumours, pT3 or higher stages, positive surgical margins, or lymph node involvement. In cases with extensive perineural invasion, particularly in adenoid cystic carcinoma, inclusion of the affected nerve pathways in the radiation field should be considered. Benign salivary gland tumours generally do not require radiotherapy, though its use may be discussed in selected cases of multirecurrent pleomorphic adenoma, where management remains controversial. This article summarizes and updates the recommendations of the Société française de radiothérapie oncologique (the French society for radiation oncology) regarding the indications and technical aspects of radiotherapy for salivary gland tumours, with emphasis on fractionation schedules, target volume delineation, and organ-at-risk sparing.

Gliomas are the most frequent malignant primary brain tumours in adults. The proximity of organs at risk, the infiltrating nature, and the radioresistance of gliomas have to be taken into account in the choice of prescribed dose and technique of radiotherapy. The management of glioma patients is based on clinical factors (age, Karnofsky performance status) and tumour characteristics (histology, molecular biology, tumour location), and strongly depends on available and associated treatments, such as surgery, radiotherapy, and chemotherapy. The knowledge of molecular biomarkers is currently essential; they are increasingly evolving as additional factors that facilitate diagnostics and therapeutic decision-making. We present the update of the recommendations of the Société française de radiothérapie oncologique (the French Society for Radiation Oncology) on the indications and the technical procedures for performing radiotherapy in patients with gliomas.

We present the updated recommendations from the Société française de radiothérapie oncologique (SFRO, the French society for radiation oncology) regarding the use of external beam radiotherapy and brachytherapy in the management of anal cancer. Anal cancer is a rare malignancy with an increasing incidence, largely due to the high prevalence of Human papillomavirus infection. It primarily affects females over 65years of age. The most common histological type is squamous cell carcinoma. The standard treatment involves a combination of intensity-modulated radiotherapy and concurrent chemotherapy with 5-fluorouracil (or capecitabine) and mitomycin. A localized boost dose to the tumour can be delivered either by external beam radiotherapy or brachytherapy. Recent studies have demonstrated that intensity-modulated radiotherapy helps avoid treatment interruptions, which are considered detrimental to efficacy. However, while radiotherapy achieves good outcomes for T1-T2 tumours without nodal involvement, T3-T4 stages or tumours with nodal involvement are associated with a poorer prognosis. Therefore, concomitant chemotherapy (5-fluorouracil or capecitabine with mitomycin) is recommended for tumours greater than 3cm or those with nodal invasion. This approach remains a topic of debate for early-stage tumours. Target volumes, organs at risk delineation, doses, and fractionation regimens are discussed with respect to the balance between treatment efficacy and toxicity. Follow-up recommendations are provided to ensure early detection of cancer recurrence and late treatment-related side effects.

Sinonasal cancers, including tumours of the nasal cavity, ethmoid, maxillary, sphenoid, and frontal sinuses, account for 3 to 5 % of head and neck malignancies. While the majority are carcinomas, other histologic types such as mucosal melanomas, sarcomas, and lymphomas may also occur. These tumours often present with non-specific symptoms and exhibit a heterogeneous prognosis. The Réseau d'expertise français des cancers ORL rares (the French expert network for rare head and neck cancers), accredited by the Institut national du cancer (the French national cancer institute), is responsible for maintaining the national registry and coordinating rare cancer multidisciplinary tumour boards at both regional and national levels. These boards incorporate expert pathological review through Refcorpath (when appropriate) and provide therapeutic recommendations. Due to the distinct characteristics of these tumours, including histologic subtype, grade, risk of nodal involvement, and surgical approach, careful consideration must be given to target volume delineation during locoregional radiotherapy. This article provides an updated overview of the Société française de radiothérapie oncologique (the French society for radiation oncology) recommendations concerning the indications for radiotherapy in sinonasal cancers. It covers key aspects such as treatment planning, techniques, dose and volume specifications, and post-treatment follow-up.

In accordance with the advancement of therapies for skin malignancies, the Japanese Dermatological Association and Japanese Skin Cancer Society updated guidelines for skin malignancies to reflect current clinical practices. Basal cell carcinoma (BCC) is one of the most ordinary malignant cutaneous tumors and its incidence continues to grow in many countries. Clinically, BCCs in East Asian populations are usually pigmented, and 88.3% of total BCCs in Japanese patients are pigmented. However, a low proportion of BCCs in Western populations are pigmented. Therefore, diagnosis and tumor border evaluation of BCCs in Western populations are relatively difficult. From these characteristics, clinical guidelines for East Asian BCCs should differ from those for Western BCCs. This revised Japanese clinical guideline for BCC was also undertaken by a committee comprising experts across relevant fields who meticulously reviewed and systematized a wide range of literature on BCC to develop comprehensive, evidence-based guidelines. Literature searches were conducted by the Japan Medical Library in accordance with the Minds Clinical Practice Guideline Creation Manual 2020, ver. 3.0. Four clinical questions (CQs) were established, and corresponding recommendation statements were provided for each CQ. There are about the reduced margin resection for pigmented BCCs, the radiotherapy for the recurrent BCCs, the topical immune response modifiers, and the systemic therapy using immune checkpoint inhibitors. This Japanese clinical guideline for BCC will help clinicians select suitable therapies for BCCs in East Asia.

Neuroendocrine neoplasms (NENs) of the gastroenteropancreatic (GEP) tract represent a rare and heterogeneous group of malignancies. They are distinguished into well-differentiated and poorly differentiated neoplasms, with clinical behavior ranging from relatively indolent to fast-growing, respectively. Surgery is the curative option for localized disease, especially in well-differentiated neoplasms, while various systemic therapies are approved and clinically available for advanced disease. However, considering the complexity of these malignancies, the choice of therapeutic strategy must take into account multiple factors, such as histological diagnosis, primary site, extent of disease, evolution features, functional status, patients and treatment characteristics, treatment availability, and safety profile. A multidisciplinary approach dedicated to NENs and conducted by experienced teams is therefore strongly recommended. Since 2013, the Italian Association of Medical Oncology (AIOM), in collaboration with the Italian Association for Neuroendocrine Tumors (ITANET), has produced guidelines using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach for assessing the certainty of evidence. This updated version (2024) summarized the main diagnostic and therapeutic decision-making processes on specific topics selected by a panel of experts from the AIOM, ITANET, and other national scientific societies with the aim of guiding clinicians in the diagnosis, treatment, and monitoring of patients with GEP-NENs. The integration of these guidelines into daily clinical practice is expected to improve patient care and drive the evolving landscape of GEP-NEN management.

The treatment landscape of invasive early-stage and metastatic breast cancer is evolving constantly. These NCCN Guidelines Insights focus on recent updates included in the most recent version (version 5.2025) of the NCCN Guidelines for Breast Cancer specific to workup, locoregional therapy, surveillance, and systemic neoadjuvant/adjuvant therapy recommendations for invasive, nonmetastatic breast cancer.

The NCCN Guidelines for Prostate Cancer provide a framework on which to base decisions for patients with prostate cancer across the disease spectrum. The Guidelines sections included in this article focus on metastatic castration-sensitive prostate cancer (mCSPC), nonmetastatic castration-resistant prostate cancer (CRPC), and metastatic CRPC (mCRPC). For patients with mCSPC, disease characteristics, such as whether metastases arose synchronously or metachronously and the degree of metastatic burden, impact therapy decisions, including how much treatment intensification is appropriate and when prostate-directed and/or metastasis-directed therapy should be considered. In the mCRPC setting, androgen deprivation therapy is continued with the sequential or concurrent addition of certain androgen receptor pathway inhibitors, chemotherapies, immunotherapies, radiopharmaceuticals, and/or targeted therapies. The NCCN Prostate Cancer Panel emphasizes a shared decision-making approach in all disease settings based on patient preferences, prior treatment exposures, biomarkers, the extent and location of metastases, symptoms, and potential side effects.

This article presents an update of the French national guidelines for the management of penile cancer, with recommendations on dose and volume for radiotherapy and brachytherapy. Multidisciplinary management and centralization in high-level of expertise centres is key for the management of this rare malignancy. For patients at high-risk of having micrometastatic disease (stage T1b or higher), a dynamic sentinel node biopsy should be offered as surgical staging and human papillomavirus status should be obtained. Organ-preservation with brachytherapy should be discussed whenever it is possible (tumours limited to the glans). For locoregionally advanced diseases, chemoradiotherapy as primary treatment could be discussed.

Since the publication of the Japanese guidelines for the management of cutaneous lymphomas in 2020, the WHO classification of hematolymphoid neoplasms has been updated, and a number of novel systemic drugs for cutaneous T-cell lymphoma have been approved in Japan. In 2025, we revised the Japanese guidelines for the management of cutaneous lymphomas in consideration of recent advances in our understanding of the pathophysiology and classification of cutaneous lymphomas, together with the update in treatment strategies reflecting the advent of novel drugs. This revision was also conducted under the Japanese Dermatological Association's commission, incorporating expert reviews and public comments. In addition to a brief explanation of the epidemiology, diagnosis, staging system, prognosis, and management of the different types of cutaneous lymphomas, we herein provide recommendations for 12 clinical questions (CQs) regarding treatment options that may vary even among experts. A systematic review process and the selection of recommendations to individual CQs were conducted in accordance with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) scheme by a multidisciplinary expert panel consisting of dermatologists, hematologists, and a radiation oncologist. In these guidelines, we present outlines of the revised Japanese guidelines for the management of cutaneous lymphomas.

Liver cancer is the sixth most common cancer worldwide, with 905,677 new cases in 2020, and the third leading cause of cancer-related deaths globally. Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer and accounts for approximately 75% to 85% of cases. Ultimately, the management of HCC encompasses multiple disciplines including hepatologists, diagnostic radiologists, pathologists, transplant surgeons, surgical oncologists, radiation oncologists, and more. The development of a multidisciplinary clinic with dedicated tumor board review has been shown to increase survival in these patients with HCC. This document aims to guide the imaging of HCC, including screening, staging, active surveillance during liver-directed therapy, and in the setting of previously treated HCC. 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.

Ovarian cancer remains the sixth most common cause of cancer mortality in women in the United States and is a leading cause of mortality among patients with gynecologic malignancies. Imaging plays an important role in pretreatment staging of epithelial ovarian cancers, the evaluation of posttreatment response, and follow-up. Accurate pretreatment imaging is integral to determine appropriate first-line therapy. By delineating the extent of disease, imaging can assist decision making regarding the likelihood of optimal primary cytoreduction or need for neoadjuvant chemotherapy when optimal cytoreduction is not felt to be achievable. Contrast-enhanced CT serves as a mainstay modality for the pretreatment assessment of ovarian cancer, with MRI, PET/CT, and, in some instances, PET/MRI used in the pretreatment setting. CT and PET/CT are also integral to assessing response, including in the suspected recurrence setting, with MRI and PET/MRI being used in select cases. 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.

Imaging associated with staging and follow-up of leukemia can play an important role in accurately assessing disease; however, the type of imaging and usefulness varies significantly by the subtype of leukemia. This document reviews the current literature regarding the impact of imaging for both staging and surveillance of several of the most common leukemic variants. These include acute lymphoblastic leukemia, acute myeloid leukemia, chronic lymphocytic leukemia, Richter transformation, and chronic myeloid leukemia. 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.

In rectal cancer, because of the need for high-resolution anatomic detail in determining local tumor extension, imaging for local staging and restaging of the primary tumor in the pelvis is considered separately from the evaluation of distant metastatic disease in the chest, abdomen, and pelvis, often resulting in the need for a combination of modalities to fully stage the patient. 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.

The role of imaging in initial staging of colon cancer, and in posttreatment restaging or surveillance, is most beneficial in identifying distant metastases in the chest, abdomen, and pelvis, regardless of primary T or N stage. Appendiceal cancers are classified separately and managed differently than colon cancer; however, initial staging and postoperative surveillance is also primarily focused on detection of distant metastatic disease, usually in the abdomen and pelvis. 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.