Radiomics is a developing new discipline that analyzes conventional medical images to extract quantifiable data that can be mined for new biomarkers that show the biology of pathological processes at microscopic levels. These data can be converted into image-based signatures to improve diagnostic, prognostic and predictive accuracy in cancer patients. The combination of radiomics and molecular data, called radiogenomics, has clear implications for cancer patients’ management. Though some studies have focused on radiogenomics signatures in hepatocellular carcinoma patients, only a few have examined colorectal cancer metastatic lesions in the liver. Moreover, the need to differentiate between liver lesions is fundamental for accurate diagnosis and treatment. In this review, we summarize the knowledge gained from radiomics and radiogenomics studies in hepatic metastatic colorectal cancer patients and their use in early diagnosis, response assessment and treatment decisions. We also investigate their value as possible prognostic biomarkers. In addition, the great potential of image mining to provide a comprehensive view of liver niche formation is examined thoroughly. Finally, new challenges and current limitations for the early detection of the liver premetastatic niche, based on radiomics and radiogenomics, are also discussed.

Resistance to antitumor treatments is one of the most important problems faced by clinicians in the management of colorectal cancer (CRC) patients. Cancer-Associated Fibroblasts (CAFs) are the main producers and remodelers of the extracellular matrix (ECM), which is directly involved in drug resistance mechanisms. Primary Normal Fibroblasts (NFs) and CAFs and cell lines (fibroblasts and tumor cells), were used to generate ECM and to identify its role in the oxaliplatin and cetuximab chemoresistance processes of CRC cells mediated by SNAI1-expressing fibroblasts. Matrices generated by Snai1 KO MEFs (Knockout Mouse Embryonic Fibroblasts) confer less resistance on oxaliplatin and cetuximab than wild-type MEF-derived matrices. Similarly, matrices derived from CAFs cause greater survival of colorectal cancer cells than NF-derived matrices, in a similar way to Snai1 expression levels. In addition, Snail1 expression in fibroblasts regulates drug resistance and metabolism gene expression in tumor cells mediated by ECM. Finally, a series of 531 patients (TCGA) with CRC was used to assess the role of SNAI1 expression in patients' prognosis indicating an association between tumor SNAI1 expression and overall survival in colon cancer patients but not in rectal cancer patients. SNAI1 expression in CRC cancer patients, together with in vitro experimentation, suggests the possible use of SNAI1 expression in tumor-associated fibroblasts as a predictive biomarker of response to oxaliplatin and cetuximab treatments in patients with CRC.

This systematic review aimed to consolidate current definitions of stereotactic radiotherapy, identify commonly proposed quality standards and address inconsistencies in international practices despite its extensive use. This systematic literature review followed the PRISMA methodology, conducting searches across PubMed, Embase, Cochrane, Scopus, and Epistemonikos databases between January 2001 and April 2024. Eligible articles included those explicitly defining stereotactic radiotherapy or providing detailed implementation criteria. Data extracted covered definitions, staffing needs, technological considerations, and quality assurance procedures. Analysis of 51 articles revealed significant discrepancies in stereotactic radiotherapy definitions and standards. Commonly proposed characteristics included targeting accuracy within ≤ 1 mm for SRS and ≤ 2 mm for SBRT, and high doses per fraction (≥5 Gy per fraction). Fractionation schemes varied extensively, ranging from ≤ 5 fractions (ACR-ASTRO, AAPM Task Group 101) to ≤ 12 fractions (DEGRO). Essential quality measures consistently emphasized multidisciplinary staffing involving radiation oncologists, medical physicists, radiotherapy technologists, and relevant specialists. Technical recommendations frequently highlighted high-resolution imaging methods (e.g., thin-slice CT, 4D CT), precise immobilization techniques, and daily IGRT (CBCT), alongside rigorous quality assurance protocols, including dosimetric validation and equipment checks. Although stereotactic radiotherapy is broadly adopted in daily routine practice, substantial variability exists in its definitions and implementation. This review underscores the need for unified, updated guidelines incorporating contemporary technological advancements and standardized clinical practices to ensure consistent, high-quality patient outcomes.

Stereotactic body radiotherapy (SBRT) allows high doses of radiation to be administered in a limited number of fractions. The high doses per session might allow the theoretical radioresistance of renal carcinoma to be overcome. SBRT may be a therapeutic alternative in inoperable patients with localized renal carcinoma. This review studied the available literature on the use of SBRT in inoperable localized renal carcinoma. The review including data from English-language studies was conducted in PubMed and MEDLINE between January 2010 and December 2020. Articles were included with data from patients with renal carcinoma treated with SBRT, their indications, simulation, dose and fractionation, local control, survival and side effects, comparison with other treatments, response assessment and radioimmunotherapy. The articles included were evaluated for content and validation. The immobilization systems were variable between studies. Doses and fractions were variable from 25-26 Gy in single fractions to 21-48 Gy in 3-5 fractions, with local control being around 90% with a low rate of side-effects. We review the state of the art in SBRT for renal cell carcinoma. More research is needed to determine optimal doses and fractionation, and to develop a reliable response assessment tool. The role of radioimmunotherapy in renal carcinoma is being studied.