With the capability to significantly preserve the normal brain from radiation-induced toxicities without compromising the efficacy of tumor treatments, irradiation at ultra-high dose rate referred as FLASH-RT provides a genuine therapeutic gain. Here we focus on the current shift towards hypofractionation in clinical practice and demonstrate that such an approach significantly maximizes the benefits of FLASH-RT in an orthotopic mouse model of GBM. While the clinical implementation of FLASH-RT will require modifications to standard practice such as development of FLASH-capable accelerators as well as the adaptation of treatment regimens, there are many potential benefits including: 1) an improved management of radiation resistant tumors for which dose escalation is necessary; 2) an enhanced quality of life of cancer survivors by preventing debilitating side effects; 3) minimized complications associated with organ motion and 4) an alleviated workload and reduced cost of cancer treatments.

After liver transplantation, the most common biliary complication is the anastomotic stricture, which is followed by biliary leakage. Studies have focused on the endoscopic treatment of biliary complications in transplanted patients with duct-to-duct reconstruction, showing a success rate of 70% to 80% after orthotopic liver transplantation and of 60% after living-related liver transplantation. Once the endoscopic approach fails, surgical treatment with a Roux-en-Y choledochojejunostomy is the sole alternative treatment. The aim of this prospective observational study was to analyze the efficacy and safety of fully covered self-expandable metallic stents for the treatment of posttransplant biliary stenosis and leaks in patients in whom conventional endoscopic retrograde cholangiopancreatography (ERCP) failed. From January 2008 to January 2009, 16 patients met the criteria of endoscopic treatment failure, and instead of surgery, a fully covered stent was placed. All patients had at least 6 months of follow-up (mean follow-up of 10 months). After removal, 14 patients showed immediate resolution of both the biliary stenosis and leak. After a mean of 10 months of follow-up, only 1 patient showed biliary stenosis recurrence. No major complications occurred in any of the patients, except for stent migration in 6 patients, although these presented with no clinical consequences. In conclusion, in patients not responding to standard endoscopic treatment, the placement of fully covered metal stents is a valid alternative to surgery. A cost analysis should be performed in order to evaluate whether to treat transplanted patients suffering from biliary complications with covered self-expandable metallic stent placement as first-line therapy. Liver Transpl 15: [1493][1494][1495][1496][1497][1498] 2009 Biliary complications are the most frequent complications after liver transplantation. Available data show a rate of biliary complications in transplant recipients ranging from 8% to 35%. This complication rate is higher for living-related liver transplantation (LRLTx) versus orthotopic liver transplantation (OLTx).1,2 Biliary complications include strictures, biliary leaks, stones or debris, and Oddi dysfunction. The most common biliary complication is the anastomotic stricture, which is followed by biliary leakage, although patients often develop more than 1 complication. 3Depending on the type of surgical biliary reconstruction (ie, choledochojejunostomy or duct-to-duct anastomosis), biliary complications can be treated by percutaneous transhepatic cholangiography or by endoscopic retrograde cholangiopancreatography (ERCP). ERCP is currently considered the diagnostic gold standard for patients with duct-to-duct anastomosis because it allows a direct approach for interventional procedures.2 Several studies have evaluated the endoscopic treatment of biliary complications in patients with duct-to-duct reconstruction and have shown a success rate of approxAbbreviations: ALT, alanine aminotransferase; ERCP, endoscopic retrograde c...

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