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Objective <p>To assess the local control, safety, and symptom relief of magnetic resonance-guided online adaptive stereotactic body radiation therapy (MRg-oART-SBRT) combined with systemic therapy in advanced unresectable pancreatic cancer.</p> Methods <p>This single-center, open-label, prospective trial enrolled ≥ 18-year-old patients with pathologically confirmed pancreatic ductal adenocarcinoma, including locally advanced, post-recurrent, and oligometastatic cases deemed unresectable via multidisciplinary evaluation. ECOG 0–2 patients with/without prior chemotherapy received 40–50&#xa0;Gy/5 fractions via 1.5T MR-linear accelerator with daily online adaptive radiotherapy. Primary endpoint was 6-month local control rate; secondary endpoints included 3-month pain relief, ≥G3 gastrointestinal toxicity within 90 days, and 6-month distant progression-free survival.</p> Results <p>From November 2023 to December 2024, 34 patients completed MRg-oART-SBRT. With median follow-up of 12.3 months (IQR 9.0–14.4) after radiotherapy, the 6-month and 1-year local control rate were both 80.2%. Median distant progression-free survival was 9.7 months after radiotherapy. 97% reported pain relief at 3 months after radiotherapy. Acute probably radiation-related toxicity was mild (G1–2 diarrhea 18%). Thrombocytopenia (G2–3: 18%) and palmar-plantar erythrodysesthesia (G1–2: 12%) were most common treatment-related adverse reactions.</p> Conclusion <p>MRg-oART-SBRT demonstrates encouraging short-term control, manageable toxicity, and survival signals in advanced pancreatic cancer. Larger multicenter trials with extended follow-up are warranted to validate long-term efficacy and clinical utility.</p> Trial registration <p>The study was registered on the Chinese Clinical Trial Registry, with the registration number ChiCTR2500096492.The retrospective registration date was January 24, 2025.</p>

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Magnetic resonance-guided online adaptive stereotactic body radiotherapy for advanced inoperable pancreatic cancer: a prospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月18日

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  • Chen Wang,
  • Zhiqun Wang,
  • Lang Yu,
  • Qiu Guan,
  • Tingting Dong,
  • Xiaorong Hou,
  • Haoran Xu,
  • Yue Zhang,
  • Fei Jiang,
  • Xin Lian,
  • Ke Hu,
  • Jie Qiu,
  • Fuquan Zhang

摘要

Objective

To assess the local control, safety, and symptom relief of magnetic resonance-guided online adaptive stereotactic body radiation therapy (MRg-oART-SBRT) combined with systemic therapy in advanced unresectable pancreatic cancer.

Methods

This single-center, open-label, prospective trial enrolled ≥ 18-year-old patients with pathologically confirmed pancreatic ductal adenocarcinoma, including locally advanced, post-recurrent, and oligometastatic cases deemed unresectable via multidisciplinary evaluation. ECOG 0–2 patients with/without prior chemotherapy received 40–50 Gy/5 fractions via 1.5T MR-linear accelerator with daily online adaptive radiotherapy. Primary endpoint was 6-month local control rate; secondary endpoints included 3-month pain relief, ≥G3 gastrointestinal toxicity within 90 days, and 6-month distant progression-free survival.

Results

From November 2023 to December 2024, 34 patients completed MRg-oART-SBRT. With median follow-up of 12.3 months (IQR 9.0–14.4) after radiotherapy, the 6-month and 1-year local control rate were both 80.2%. Median distant progression-free survival was 9.7 months after radiotherapy. 97% reported pain relief at 3 months after radiotherapy. Acute probably radiation-related toxicity was mild (G1–2 diarrhea 18%). Thrombocytopenia (G2–3: 18%) and palmar-plantar erythrodysesthesia (G1–2: 12%) were most common treatment-related adverse reactions.

Conclusion

MRg-oART-SBRT demonstrates encouraging short-term control, manageable toxicity, and survival signals in advanced pancreatic cancer. Larger multicenter trials with extended follow-up are warranted to validate long-term efficacy and clinical utility.

Trial registration

The study was registered on the Chinese Clinical Trial Registry, with the registration number ChiCTR2500096492.The retrospective registration date was January 24, 2025.