title: Robotic radiosurgery in pancreatic cancer: A systematic review.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Milly Buwenge, Francesco Deodato, Gabriella Macchia, Department of Radiation Oncology, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy.
authors: Milly
authors: M
authors: Buwenge
authors: Milly Buwenge, Francesco Deodato, Gabriella Macchia, Department of Radiation Oncology, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy.
authors: Francesco
authors: F
authors: Cellini
authors: Milly Buwenge, Francesco Deodato, Gabriella Macchia, Department of Radiation Oncology, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy.
authors: Nicola
authors: N
authors: Silvestris
authors: Milly Buwenge, Francesco Deodato, Gabriella Macchia, Department of Radiation Oncology, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy.
authors: Savino
authors: S
authors: Cilla
authors: Milly Buwenge, Francesco Deodato, Gabriella Macchia, Department of Radiation Oncology, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy.
authors: Francesco
authors: F
authors: Deodato
authors: Milly Buwenge, Francesco Deodato, Gabriella Macchia, Department of Radiation Oncology, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy.
authors: Gabriella
authors: G
authors: Macchia
authors: Milly Buwenge, Francesco Deodato, Gabriella Macchia, Department of Radiation Oncology, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy.
authors: Gian C
authors: GC
authors: Mattiucci
authors: Milly Buwenge, Francesco Deodato, Gabriella Macchia, Department of Radiation Oncology, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy.
authors: Vincenzo
authors: V
authors: Valentini
authors: Milly Buwenge, Francesco Deodato, Gabriella Macchia, Department of Radiation Oncology, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy.
authors: Alessio G
authors: AG
authors: Morganti
mesh_terms: D059248:Chemoradiotherapy; D019583:Dose Fractionation, Radiation; D006801:Humans; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery / Q000009:adverse effects / Q000401:mortality; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
keywords: Pancreas; Pancreatic neoplasms; Radiosurgery; Review; Robotic; Stereotactic radiotherapy; Systematic review