Practical radiation oncology · 2026
Stereotactic Body Radiation Therapy for Locally Advanced Pancreatic Adenocarcinoma: A Systematic Review and Meta-Analysis of Prospective Trials.
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Zeng K Liang, Louie Alexander V, Kotecha Rupesh, Sahgal Arjun, Zhang Zhenwei, Zhou Lili, Gevaert Thierry, Guckenberger Matthias, Kim Mi-Sook, Lo Simon, Scorsetti Marta, Slotman Ben, Tree Alison, Ng Sylvia S W
Аннотация
PURPOSE: Modern technology has facilitated dose-escalated stereotactic body radiation therapy (SBRT) through real-time soft-tissue delineation and adaptive radiation therapy for locally advanced/unresectable pancreatic cancer (LAPC). The current study examined published prospective trials in SBRT for LAPC to inform clinical decision-making with support from the International Stereotactic Radiosurgery Society.
METHODS AND MATERIALS: A systematic review and meta-analysis was conducted of all prospective trials in definitive SBRT (up to 6 fractions) for LAPC. Random-effects meta-analysis was performed, and metaregression was used to assess the effect of covariates on outcomes of interest, including local control (LC), progression-free survival (PFS), overall survival (OS), and toxicities.
RESULTS: A total of 23 prospective studies were identified, including 901 patients. Most studies (n = 21, 91.3%) used systemic therapy before SBRT and delivered a median dose of 40 Gy in 5 fractions (range, 24-50 Gy in 3-6 fractions). The pooled 12- and 24-month LC estimate was 82% and 70%, respectively; 12-month PFS and OS rates were 35% and 63%, respectively; and 24-month PFS and OS rates were 15% and 28%, respectively. On univariable metaregression, SBRT with ≥5 fractions was associated with improved 12-month LC and OS. Inclusion of an elective clinical target volume was associated with improved 24-month PFS and OS. A higher biologically effective dose (BED10) was associated with improved 24-month LC and OS. Surgery was associated with improved 12- and 24-month OS and 12-month PFS. The pooled estimate for risk of any grade 3-4 toxicities was 2%, and that of grade 5 toxicities was 0.2% (7 events), mostly gastrointestinal bleeding. There were no predictors of grade 3-4 or 5 toxicities.
CONCLUSIONS: Modern radiation therapy techniques allow safe delivery of high radiation doses for LAPC. SBRT provides excellent and durable LC with low rates of treatment-related grades ≥3 toxicities.
METHODS AND MATERIALS: A systematic review and meta-analysis was conducted of all prospective trials in definitive SBRT (up to 6 fractions) for LAPC. Random-effects meta-analysis was performed, and metaregression was used to assess the effect of covariates on outcomes of interest, including local control (LC), progression-free survival (PFS), overall survival (OS), and toxicities.
RESULTS: A total of 23 prospective studies were identified, including 901 patients. Most studies (n = 21, 91.3%) used systemic therapy before SBRT and delivered a median dose of 40 Gy in 5 fractions (range, 24-50 Gy in 3-6 fractions). The pooled 12- and 24-month LC estimate was 82% and 70%, respectively; 12-month PFS and OS rates were 35% and 63%, respectively; and 24-month PFS and OS rates were 15% and 28%, respectively. On univariable metaregression, SBRT with ≥5 fractions was associated with improved 12-month LC and OS. Inclusion of an elective clinical target volume was associated with improved 24-month PFS and OS. A higher biologically effective dose (BED10) was associated with improved 24-month LC and OS. Surgery was associated with improved 12- and 24-month OS and 12-month PFS. The pooled estimate for risk of any grade 3-4 toxicities was 2%, and that of grade 5 toxicities was 0.2% (7 events), mostly gastrointestinal bleeding. There were no predictors of grade 3-4 or 5 toxicities.
CONCLUSIONS: Modern radiation therapy techniques allow safe delivery of high radiation doses for LAPC. SBRT provides excellent and durable LC with low rates of treatment-related grades ≥3 toxicities.