Safety and Efficacy of Neoadjuvant SABR in Pancreatic Cancer: Effect of Magnetic Resonance Imaging–Guided Respiratory-Gated Adaptive Radiation Therapy

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ObjectivesWe aimed to evaluate the safety and efficacy of neoadjuvant stereotactic ablative radiotherapy (SABR) using magnetic resonance imaging-guided respiratory-gated adaptive radiotherapy (MRgRg-ART) in pancreatic cancer.Method and MaterialsWe performed a single-institution retrospective review in pancreatic cancer patients who underwent neoadjuvant SABR followed by surgical resection. After neoadjuvant chemotherapy, those considered resectable by the multidisciplinary team received SABR over 5 consecutive days using MRgRg-ART. Factors associated with severe postoperative complications (Clavien-Dindo Grade ≥ III) and prognostic factors for overall survival (OS) were analyzed.ResultsSixty-two patients were included in the analysis, with a median follow-up of 10.3 months. The median prescribed dose to the planning target volume was 50 Gy. Fifty-two (85.3%) patients underwent R0 resection, and 11 (18.0%) experienced severe postoperative complications. No factors were associated with the incidence of severe postoperative complications. There were 3 cases of locoregional recurrence, resulting in a 12-month local control rate of 93.1%. Elevated postoperative CA19-9 was significantly associated with poor OS in the multivariate analysis (p=0.037).ConclusionNeoadjuvant SABR with 50 Gy using MRgRg-ART delivered to pancreatic cancer resulted in a notable survival outcome with acceptable toxicities. Further studies are warranted to investigate the long-term effects of this method.