Magnetic Resonance Imaging (MRI) Guided Stereotactic Adaptive Radiotherapy for Targeting Abdominal Cancer

Inclusion Criteria:

• Aged 18 years or older

• Patients with diagnosis of oligometastatic disease from primary colorectal, uppergastrointestinal (e.g. gastric, oesophagus, pancreatic), breast, non-small celllung, renal cell, or gynaecological malignancy. Oligometastatic disease withcontrolled primary disease* and maximum total of 5 metastatic lesions in a maximumof 2 different organ systems in any of the following sites:

1. Liver

2. Adrenal

3. Abdomino-pelvic lymph node

4. Other abdominal site e.g. pancreatic, renal.

5. Other pelvic site

6. Bony or lung is allowed only if in conjunction with an abdominal site above

• De novo or metachronous oligometastatic disease where the original tumour site hasbeen treated with curative intent.

• Controlled primary disease in metachronous oligometastastic disease defined asat least 3 months since original tumour treated with curative intent and noprogression at primary site

• Controlled primary disease in de novo oligometastatic disease defined asprimary tumour site treated with curative intent and no progression at primarysite

• Oligometastatic disease: Histological confirmation of primary malignancy (histological confirmation of metastasis is not mandatory but should be performed inany situation where there is any diagnostic uncertainty).

• All oligometastatic sites treatable with SABR.

OR

• Patients with oligo-progressive / oligo-persistent disease in maximum total of 2oligo-progressive abdominal metastases and in a maximum 2 different organ systems

• Visible imaging defined targets and suitable for treatment with SABR

• Childs Pugh A to B7 (in case of liver treatment)

• ECOG 0 -2

• Patient consented

Exclusion Criteria:

• Contra-indication to MRI

• Previous high dose radiotherapy to a site requiring stereotactic treatment (including SIRTEX). Further SABR treatment of lesions previously treated with SABRor high dose radiotherapy is not permitted in this trial.

• Substantial overlap with a previously treated high dose (definitive or stereotacticdose) radiation volume.

• Primary prostate cancer, carcinoid tumours, germ cell tumours, lymphoma, small celltumours

• Pregnant women

• Complete response of metastatic disease to systemic therapy (i.e. no target forSABR)

• Competing medical co-morbidity with a more limited prognosis than the cancerdiagnosis