I consider radiotherapy as a third-line treatment for any symptomatic patient with persistently above normal IGF-1(≥1.5–2 ULN) on the maximum tolerated dose of first generation SSA (usually 40 mg octreotide or 120 mg lanerotide monthly) for at least 6 months and with unresectable residual tumor. Here, IGF1 is linked to neoplasm.