Five-fraction stereotactic magnetic resonance-guided adaptive radiotherapy targeting the primary tumor in metastatic pancreatic cancer

Schumann MA, Gaasch A, Boyaci S, Fuchs F, Walter F, Marschner SN, Eze C, Westphalen CB, Holch JW, Beyer G, Kunz WG, Mayerle J, Niyazi M, Belka C, Corradini S, Rogowski P (2026)

Publication Type: Journal article

Publication year: 2026

Journal

World Journal of Gastroenterology Baishideng Publishing Group Co. Limited

Book Volume: 32

Article Number: 117832

Journal Issue: 29

DOI: 10.3748/wjg.117832

Abstract

BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with most patients present with or develop metastatic disease. Despite modern multiagent chemotherapy, survival remains poor. Locoregional progression of the primary tumor often causes pain, biliary obstruction, and gastrointestinal complications. Magnetic resonance-guided radiotherapy (MRgRT) enables daily adaptive planning and real-time motion control, allowing safe dose escalation in anatomically constrained regions. We hypothesized that stereotactic magnetic resonance–guided radiotherapy provides effective and safe local tumor control in patients with metastatic PDAC (mPDAC). AIM To investigate the feasibility, efficacy, and safety of MRgRT in mPDAC. METHODS This prospective single-center observational study enrolled consecutive patients with synchronous or metachronous mPDAC treated between January 2020 and January 2025. Radiotherapy was delivered on a 0.35-T MR-Linac with 33-40 Gy in five fractions. Primary endpoint was local control; secondary endpoints included overall survival (OS), time to distant progression, toxicity, and pain relief. Prognostic clinical and treatment parameters were explored using subgroup analyses. RESULTS Twenty-four patients were included. Local control at 12 months and 24 months was 76% and 67%, respectively. Median time to distant progression was 3 months. Median OS in the entire cohort was 13 months after radiotherapy and 20 months from diagnosis, with a 1-year OS rate of 49%. Palliative treatment intent was associated with shorter survival (5 months, P = 0.001). OS was longer in patients with single-organ disease (P = 0.003), stable metastatic disease after systemic therapy (P = 0.0027), carbohydrate antigen 19-9 < 500 U/mL (P = 0.03), and Eastern Cooperative Oncology Group 0 (P = 0.023). Two acute grade 3 gastrointestinal events (duodenal hemorrhage, biliary duct obstruction) occurred; no late grade ≥ 3 toxicities were observed. Pain relief was reported by 89% of symptomatic patients. CONCLUSION MRgRT is a feasible and well-tolerated treatment providing high local control and effective pain palliation in selected patients with mPDAC.

Involved external institutions

Klinikum der Universität München (LMU Klinikum) DE Germany (DE) Deutsches Krebsforschungszentrum (DKFZ) DE Germany (DE)

How to cite

APA:

Schumann, M.A., Gaasch, A., Boyaci, S., Fuchs, F., Walter, F., Marschner, S.N.,... Rogowski, P. (2026). Five-fraction stereotactic magnetic resonance-guided adaptive radiotherapy targeting the primary tumor in metastatic pancreatic cancer. World Journal of Gastroenterology, 32(29). https://doi.org/10.3748/wjg.117832

MLA:

Schumann, Mohamed A., et al. "Five-fraction stereotactic magnetic resonance-guided adaptive radiotherapy targeting the primary tumor in metastatic pancreatic cancer." World Journal of Gastroenterology 32.29 (2026).

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