We present the updated recommendations of the Société française de radiothérapie oncologique (SFRO, the French society for oncological radiotherapy) for rectal cancer radiotherapy. The standard treatment for locally advanced rectal cancer consists in chemoradiotherapy followed by radical surgery with total mesorectal resection and adjuvant chemotherapy according to nodal status. Although this strategy efficiently reduced local recurrences rates below 5 % in expert centres, functional sequelae could not be avoided resulting in 20 to 30 % morbidity rates. The early introduction of neoadjuvant chemotherapy followed by chemoradiation has proven to be beneficial in recent trials, in terms of recurrence-free and metastasis-free survivals becoming the new standard treatment strategy. Complete pathological responses were obtained in 15 % of tumours treated by chemoradiotherapy, even reaching up to 30 % of tumours when neoadjuvant chemotherapy is associated to chemoradiotherapy. These good results question the relevance of systematic radical surgery in good responders. Personalized therapeutic strategies are now possible by improved imaging modalities with circumferential margin assessed by magnetic resonance imaging, by intensity-modulated radiotherapy and by refining surgical techniques, and contribute to morbidity reduction. Keeping the same objectives, ongoing trials are now evaluating therapeutic de-escalation strategies, in particular rectal preservation for good responders after neoadjuvant treatment or radiotherapy omission in selected cases.

Renal cell carcinoma represents the 14th most frequent tumour worldwide, but its incidence is increasing partly due to incidental diagnoses. As a result, these tumours are diagnosed in patients at an increasingly advanced age, often frail and with comorbidities. Most renal cell carcinoma cases are clear cell carcinoma (80 %), with papillary tumours being the second most frequent histological subtype. The standard of care for localized RCC is surgery, with partial nephrectomy or radical nephrectomy being recommended for T1 and T2 tumours, respectively. Thermoablative strategies have been developed over the past decade for patients who are not amenable to surgery and/or with impaired renal function. Active surveillance remains an alternative in the case of small low-grade renal cell carcinoma. Recent research has evaluated stereotactic ablative body radiotherapy as a well-tolerated and effective treatment for small renal tumours essentially for the management of both T1a and T1b tumours. This article aims to report the recommendations of the Société française de radiothérapie oncologique (SFRO, the French society for radiation oncology) on the role of radiotherapy in the management of localized renal cell carcinoma. These guidelines describe both treatment planning modalities, target volumes, and follow-up procedures. They also focus on the impact of radiotherapy on renal function, and the specific dosimetric constraints to be implemented.

This article aims to report the recommendations from the French society for radiation oncology (Société française de radiothérapie oncologique, SFRO) on the use of external beam radiotherapy in the management of testicular cancer. Testicular cancers account for 1 % of adult neoplasms yet represent the most frequently diagnosed urological tumour in young men. Most of testicular cancers (95 %) are germ cell tumours, which include both seminomatous and non-seminomatous tumours. Surveillance is the preferred option for stage I seminoma following orchidectomy, but adjuvant chemotherapy or para-aortic radiotherapy remain possible options. For stages IIA/IIB seminoma, either chemotherapy or para-aortic and ipsilateral iliac nodal areas irradiation can be proposed. In non-seminomatous tumours, chemotherapy is the standard treatment. Target volumes, doses, fractionation regimens, and considerations for organs at risk are discussed. Follow-up recommendations are provided, aiming to ensure both early detection of cancer recurrence and late treatment-related side effects. These guidelines highlight the importance of a multidisciplinary approach for the management of germ cell tumours as well as careful consideration of long-term toxicities, in this young patient population with a long-life expectancy.

To date, no consensus guidelines have been published that systematically guide delineation of primary and nodal Clinical Target Volumes (CTVs) in patients who require post-operative radiotherapy (PORT) for mucosal Head and Neck squamous cell carcinoma (HNSCC). As a result, significant individual, institutional and national variation exists in the way that CTVs are delineated in the post-operative setting, leading to considerable heterogeneity in radiotherapy treatment.

The growing use of reduced-dose radiotherapy in patients with primary cutaneous lymphoma is a promising development. Nevertheless, the absence of controlled clinical trials to ascertain standardized doses for each specific type constitutes a significant impediment to the advancement of this field. This expert opinion strongly advocates for advancements in radiation oncology practice that address the unique complexities of primary cutaneous lymphoma. By refining our methodologies, we can optimize patient care and outcomes in this dynamic field.

At least one-third of patients with localized rhabdomyosarcoma (RMS) and 60-70% of patients with metastatic RMS experience progressive disease or relapse. Following relapse, outcomes generally remain poor with limited treatment options and a high risk of subsequent recurrence. Optimal treatment requires a multidisciplinary approach incorporating chemotherapy with local control. Given the complexity of managing relapsed RMS and the challenges in developing effective treatment strategies, we aim to present clear and practical recommendations on the management of these patients across Europe. These recommendations were developed collaboratively by a group of pediatric and adolescent sarcoma experts from the European paediatric Soft Tissue Sarcoma Study Group. A careful review of the literature was performed to ensure that wherever possible recommendations are supported by the results of clinical trials or substantive retrospective reports. Such recommendations provide a standardized approach to managing relapsed cases, improving patient outcomes and offering a framework for clinicians to make informed decisions.

The Chinese Society for Therapeutic Radiology Oncology, the Chinese Anti-Cancer Association, the Chinese Society of Clinical Oncology, the Head and Neck Cancer International Group, the European Society for Radiotherapy and Oncology, and the American Society for Radiation Oncology collaboratively developed evidence-based guidelines and a comprehensive contouring atlas for neck target volume delineation in nasopharyngeal carcinoma. These guidelines address five key challenges in modern radiotherapy practice: margin design of clinical target volume; nodal target volume delineation after induction chemotherapy; delineation of equivocal nodes evident on imaging; low-risk clinical target volume delineation based on regional stepwise extension patterns; and modifications for anatomical boundaries of lymphatic areas. Developed through a rigorous systematic review and expert appraisal process by a panel of 50 international, multidisciplinary members from 17 countries and regions, these guidelines incorporate the latest advances in nasopharyngeal carcinoma diagnosis and treatment. They reflect contemporary therapeutic concepts and elaborate on current practice variations. These guidelines aim to standardise global practice, substantially improving consistency and reducing variability in nasopharyngeal carcinoma radiotherapy target delineation.

The Chinese Society for Therapeutic Radiology Oncology, the Chinese Anti-Cancer Association, the Chinese Society of Clinical Oncology, Head and Neck Cancer International Group, the European Society for Radiotherapy and Oncology, and the American Society for Radiation Oncology jointly developed evidence-based guidelines and a contouring atlas for primary target volume delineation for radiotherapy in nasopharyngeal carcinoma. The guidelines systematically address three crucial challenges: margin design of clinical target volumes; target volume delineation after induction chemotherapy; and low-risk clinical target volume delineation based on local stepwise extension patterns. Based on a comprehensive systematic review and critical appraisal by an international multidisciplinary panel of 50 nasopharyngeal carcinoma specialists from 17 countries and regions, these guidelines are in keeping with advances in nasopharyngeal carcinoma diagnosis and treatment, embodying contemporary treatment concepts, and elaborating on the differences in practice. These guidelines aim to support global clinical practice in radiotherapy target volume delineation, substantially enhancing homogeneity and reducing variability in nasopharyngeal carcinoma target delineation.

Photodynamic diagnosis (PDD) significantly enhances the detection of bladder cancer (BCa) and is able to reduce the risk of disease recurrence, although it may not affect disease progression and mortality rates. Despite its advantages, widespread adoption of PDD is limited by cost considerations and the absence of unified guidelines on its application, highlighting the need for continued evaluation of its cost-effectiveness across different healthcare settings. To date, no specific recommendations for PDD in non-muscle invasive bladder cancer (NMIBC) management have been provided by the Italian Society of Urology (Società Italiana di Urologia, SIU). Therefore, the aim of this paper is to report on the position of SIU on the role of PDD in NMIBC. According to available evidence and international guidelines (i.e., European Association of Urology, American Association of Urology, National Comprehensive Cancer Network and other national guidelines) on BCa, a Panel of twelve Italian urologists with long and renowned experience in treating BCa defined current indications for PDD in the management of NMIBC. The final document was ultimately reviewed and approved by the expert Panel prior to publication. The consensus highlighted the role of PDD during the initial transurethral resection of the bladder (TURB) to detect carcinoma in situ (CIS) and small papillary lesions that might otherwise be missed, leading to disease persistence. Additionally, in clinical scenarios such as positive urine cytology with negative cystoscopy, PDD-guided biopsies can significantly increase the detection of CIS. For cases involving larger or multifocal tumors, or atypical macroscopic features during cystoscopy, PDD is valuable for identifying subtle high-grade disease elements, thereby facilitating more precise risk stratification and targeted treatment planning. In the setting of re-TURB, aiming to detect the presence and extent of concomitant CIS and to gain all possible additional information, PDD may be used in all procedures if not already performed during initial resection. Finally, PDD may be used for disease recurrence in patients with a history of HG NMIBC and to evaluate the response of CIS to Bacillus Calmette-Guérin (BCG). This position paper of the SIU highlights the current recommendation for the use of PDD in the management of NMIBC, from initial TURB, to re-TURB and follow-up.

UK Guidelines for the management of uveal melanoma (UM) were first published in 2015 using an evidence-based systematic approach. The primary aim of this guideline was to optimise patient care by providing recommendations based on the best available scientific evidence. The resulting guideline reflected the strengths and weaknesses of the available evidence, made recommendations that were clinically impactful around prognostication, surveillance, and treatment for patients with primary lesions and metastatic disease. The guideline development process and content met the standards required by NICE and were ultimately NICE accredited. Here, we present an update to these guidelines, highlighting where practice or treatment has changed to such an extent that the original recommendations are now out of date. Presented here are updated guidelines on molecular and genetic testing, management of metastatic disease and clinical surveillance.

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal (GI) tract and has been regarded as one of the most successful models of targeted therapy in solid tumors to date. In recent years, a deeper understanding of GIST biology, coupled with innovations in molecular pathology, imaging studies, endoscopic and minimally invasive techniques, as well as the development of targeted medications, has led to the evolution of the treatment paradigm into a multidisciplinary approach centered around surgery, which involves pathology, gastroenterology (including endoscopy), oncology, radiology, and interventional radiology, etc. Among all these modalities, surgical resection remains the primary and most effective treatment modality. Surgeons are expected to play a leading role in the comprehensive management of patients with GISTs. Recently, the Expert Working Group on Diagnosis and Treatment of Gastrointestinal Stromal Tumors under the Chinese College of Surgeons, Chinese Medical Doctor Association has released the Chinese Expert Consensus on Standardized Surgical Management of Gastrointestinal Stromal Tumors (2025 Edition), integrating the latest evidence and clinical insights to provide authoritative guidance for the surgical treatment of GISTs in clinical practice.

Cyclin-dependent kinase (CDK)4/6 inhibitors have become a key component of adjuvant treatment for patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) early breast cancer who are at high risk of recurrence. The addition of abemaciclib and ribociclib to standard endocrine therapy has demonstrated clinically meaningful improvements in invasive disease-free survival, supported by the monarchE and NATALEE trials, respectively. With expansion of patient eligibility for CDK4/6 inhibitors, multidisciplinary coordination among medical oncologists, surgeons, nurses, pharmacists, and other health care providers is critical to optimizing patient identification, monitoring, and management of adverse events. This expert guidance document provides practical recommendations for implementing adjuvant CDK4/6 inhibitor therapy in routine clinical practice, incorporating insights from multiple specialties and with patient advocacy representation. Key considerations include patient selection based on clinical trial data, treatment duration, dosing schedules, adverse event profiles, monitoring requirements, drug-drug interactions, and patient-specific factors such as tolerability, cost, and quality of life. This guidance aims to support Canadian clinicians in effectively integrating CDK4/6 inhibitors into clinical practice, ensuring optimal patient outcomes through a multidisciplinary and patient-centric approach.

Endoscopists performing upper gastrointestinal (UGI) endoscopy should train to recognize the appearance of early esophageal cancer and its precursor lesions, for Barrett neoplasia and for squamous neoplasia, to improve detection rates.Every endoscopist should have achieved competency in UGI endoscopy before commencing training in optical diagnosis in the UGI tract, and this requires personal experience of 300 UGI endoscopies and meeting the ESGE quality measures for UGI endoscopy.

The liver is the main target organ for hematogenous metastases from colorectal cancer, and colorectal liver metastasis is one of the most difficult and challenging situations in the treatment. In order to improve the diagnosis and comprehensive treatment in China, the Guidelines have been edited and revised for seven times since 2008, including the overall evaluation, personalized treatment goals and comprehensive treatments, to prevent the occurrence of liver metastases, increase the local damage rate of liver metastases, prolong long-term survival, and improve quality of life. The revised Guideline version 2025 includes the diagnosis and follow-up, prevention, multidisciplinary team (MDT), surgery and local ablative treatment, neoadjuvant and adjuvant therapy, comprehensive treatment. The revised Guideline emphasizes precision treatment based on genetic molecular typing, especially recommending immune checkpoint inhibitors for dMMR/MSI-H patients, and enriched local treatment methods, such as liver transplantation, yttrium-90 microsphere selective internal radiotherapy, etc. The revised Guideline includes state-of-the-art experience and findings, detailed content, and strong operability.

Nasopharyngeal cancers are rare in France but much more common in endemic regions such as Southeast Asia, North Africa, and Alaska. Radiotherapy remains the cornerstone of treatment, combined with chemotherapy for locally advanced cases. The technical aspects of radiotherapy are complex due to the proximity of numerous critical structures. Recent studies have explored the benefits of combining systemic therapies, such as immunotherapy, with radiotherapy, the advantage of de-escalating irradiated lymph node volumes to reduce toxicity while maintaining therapeutic efficacy, and the value of monitoring via Epstein-Barr virus circulating tumour DNA to improve patient follow-up. Here, we present the updated recommendations of the French society of radiation oncology (Société française de radiothérapie oncologique, SFRO) concerning the indications and technical modalities of radiotherapy in nasopharyngeal cancers.

Background: Differentiated thyroid cancer (DTC) is the most prevalent cancer of thyroid and is among the most frequently diagnosed cancers in the United States. The practice guidelines of the American Thyroid Association (ATA) for DTC management in adult patients (previously combined with thyroid nodules) were published initially in 1996, with subsequent revisions based on advances in the field. The goal of this update is to provide clinicians, patients, researchers, and those involved in health policy with rigorous, comprehensive, and contemporary guidelines to assist in the management of adult patients with DTC, emphasizing the patient journey beginning with a thyroid cancer diagnosis. Methods: The questions addressed were based, in part, on prior versions of the guidelines, with input from a larger, more diverse complement of stakeholders. The panel included members from multiple specialties involved in thyroid cancer care, including a patient advocate and an expert in systematic reviews/meta-analyses/guidelines who educated and supported task force members. The panel conducted systematic literature reviews to inform the recommendations and commissioned two additional systematic reviews. Published English-language articles were eligible for inclusion, with a final search date of July 1, 2024. A modified Grading of Recommendations Assessment, Development and Evaluation system was used for critical appraisal of evidence and determining the quality of data. The guidelines panel had editorial independence from the ATA. Competing interests of task force members were pre-vetted, regularly updated, communicated with task force members, and assessed and managed by ATA leadership and the Clinical Practice Guidelines and Statements Committee. Results: These revised guidelines begin with the initial cancer diagnosis and continue with recommendations for staging and risk assessment, initial treatment decisions, assessment of treatment responses, monitoring approaches, diagnostic testing, and subsequent therapies based on the strength of evidence for response and consideration of side effects and outcomes. Patient-reported outcomes and identified areas of need for additional high-quality research are highlighted. Conclusions: These revised evidence-based recommendations inform clinical decision-making in the management of DTC that reflect the changing science and optimize the evidence-based clinical care of patients throughout their journey with DTC. Critical areas of need for additional research are highlighted.

We present the updated recommendations of the French Society of Radiotherapy Oncology (Société française de radiothérapie oncologique, SFRO) on radiotherapy for pancreatic cancer. The place of radiation therapy in the treatment of patients with resectable or locally advanced pancreatic cancer is still controversial. In the postoperative setting, the standard treatment is adjuvant chemotherapy with 5-fluorouracil, irinotecan and oxaliplatin ("folfirinox" regimen) for 6 months. Adjuvant chemoradiotherapy may be beneficial for patients with N0 cancer. After induction chemotherapy, neoadjuvant chemoradiotherapy is used for borderline tumours in order to increase the chances of complete resection (R0) even if its benefit on patient survival has not been demonstrated. For locally advanced tumours, induction chemotherapy followed in non-progressive patients by chemoradiotherapy increases local control and the chances of resectability. Intensity-modulated radiotherapy reduces the doses received by organs at risk. Tumour movements related to breathing must be taken into account. Stereotaxic radiotherapy increases the dose received by the tumour while protecting neighbouring healthy organs.

We present the recommendations of the Société française de radiothérapie oncologie (SFRO; the French society for radiation oncology) regarding the indications and techniques for external beam radiotherapy for bladder cancer. Together with radical cystectomy, trimodal therapy for well-selected patients is one of the standard-of-care treatments in the management of localized muscle invasive bladder cancer, defined as a maximal trans-urethral resection of the bladder tumour, followed by radiotherapy and concomitant chemotherapy. Adjuvant radiotherapy is an option for patients with pathological high-risk bladder cancer. In the metastatic setting, consolidative radiotherapy is still under evaluation. Palliative radiotherapy using a hypofractionated regimen is a valid option in symptomatic patients.

An Italian guideline panel issued the national recommendations for breast cancer diagnosis, staging, and preoperative planning. The panel employed the ADOLOPMENT process to adopt or adapt the guidelines developed by the European Commission Initiative on Breast Cancer (ECIBC). This process utilises the Grading of Recommendations Assessment, Development and Evaluation evidence-to-decision framework. Hereby, we present 15 prioritised recommendations from the second chapter of the Italian guidelines. All of the recommendations as originally developed by the ECIBC were adopted. For the assessment of women with positive screening result, the diagnostic recommendations suggest using digital breast tomosynthesis instead of additional mammographic projections. Recommendations include using needle core biopsy (NCB) instead of fine-needle aspiration for suspicious lesions, and stereotactic-guided -rather than ultrasound-guided- NCB for suspicious calcifications. For preoperative planning, they recommend clip marking after biopsy and not using additional magnetic resonance imaging (MRI) for confirmed ductal carcinoma in situ. Contrast-enhanced mammography is preferred over MRI for presurgical planning, when needed. Other imaging tests are not recommended for stage I, IIa, and IIb BC without signs of metastasis, while positron emission tomography-computed tomography alone is suggested for stage III BC. Adjuvant hormone therapy is recommended when 1% or more tumour cells show oestrogen or progesterone receptor positivity, which replaces the 10% threshold. Adopting shared and trustworthy guidelines for BC screening across Europe will help standardise the process across settings and advance healthcare quality and equity.

The 9th TNM Classification for Lung Cancer, based on IASLC data, was published in January 2025. This edition is currently available online as a download or printed manual in English ( www.iaslc.org/research-education/publications-resources-guidelines/staging-manual-thoracic-oncology-3rd-edition ). Key changes include the subclassification of pN2 into pN2a/b and M1c into M1c1/2, leading to improved prognostic differentiation and reclassification of individual TN combinations into UICC stages. The T-category remains formally unchanged but has been anatomically refined. A survey of 18 pathology institutes conducted by the Thoracic Pathology Working Group revealed that 83% use TNM 8 and only 22% already use TNM 9; 39% subclassify pN2 and 67% document pleural status (PL0-3). The Thoracic Pathology Working Group recommends immediate structured implementation of TNM 9, in particular the N2 subclassification, as well as dual documentation of TNM 8 and 9 during the transition phase until January 2026. Formal implementation in clinical practice is planned for this date. R0(un) should be commented on optionally, and the pleural status should be specified in detail (PL0-3).