title: Stereotactic ablative radiation therapy as a potential curative treatment in duodenal adenocarcinoma: a case report.
abstract: OBJECTIVE
  One of the rarest gastrointestinal neoplasm is small bowel cancer. Experience with its treatment modalities is limited. Stereotactic ablative radiation therapy (SABR) has improved, with image-guided radiation therapy becoming a curative option in many tumors. Especially when surgery cannot be performed due to comorbidities, SABR provides a good toxicity profile and an excellent tumor control rate owing to its specific schedule: high dose on a limited and well-defined area.
  
  
  METHODS
  An 83-year-old man had arterial hypertension and congestive cardiomyopathy, with recent history of upper abdominal pain, weight loss over 10 kg, and progressive severe fatigue. The patient underwent endoscopy that showed a large mass partially obstructing the second part of the duodenum; a biopsy revealed a moderately differentiated adenocarcinoma. A staging CT scan confirmed localized disease. Due to the patient's age and comorbidities, a SABR was proposed as the preferred treatment. In order to localize the tumor during radiotherapy sessions, surgical clips were placed endoscopically next to the lesion as fiducial markers. The patient received 25 Gy in 5 fractions on alternate days.
  
  
  RESULTS
  Resolution of duodenal obstruction and bleeding lasted for 14 months. The patient died of myocardial infarction.
  
  
  CONCLUSIONS
  This case suggests that SABR could have a role in the palliative treatment of small bowel cancers, with good toxicity profile, particularly in patients for whom surgical treatment is not a viable option.
authors.affiliation: UPMC San Pietro Advanced Radiotherapy Center, Rome - Italy.
authors.forename: Francesco Maria
authors.initials: FM
authors.lastname: Aquilanti
authors.affiliation: UPMC San Pietro Advanced Radiotherapy Center, Rome - Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Barba
authors.affiliation: UPMC San Pietro Advanced Radiotherapy Center, Rome - Italy.|Radiation Therapy Department, San Pietro Fatebenefratelli Hospital, Rome - Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Bianciardi
authors.affiliation: UPMC San Pietro Advanced Radiotherapy Center, Rome - Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Tolu
authors.affiliation: UPMC San Pietro Advanced Radiotherapy Center, Rome - Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Nardiello
authors.affiliation: Radiation Therapy Department, San Pietro Fatebenefratelli Hospital, Rome - Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Hamid Raza
authors.affiliation: Radiation Therapy Department, San Pietro Fatebenefratelli Hospital, Rome - Italy.
authors.forename: Randa
authors.initials: R
authors.lastname: El Gawhary
authors.affiliation: Radiation Therapy Department, San Pietro Fatebenefratelli Hospital, Rome - Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: D'Ambrosio
authors.affiliation: UPMC San Pietro Advanced Radiotherapy Center, Rome - Italy.|Radiation Therapy Department, San Pietro Fatebenefratelli Hospital, Rome - Italy.
authors.forename: PierCarlo
authors.initials: P
authors.lastname: Gentile
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000369:Aged, 80 and over; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D016634:Radiosurgery / Q000379:methods*; D016896:Treatment Outcome