Stereotactic Body Radiation Therapy Shows Comparable Outcomes to Conventional Chemoradiation for Pancreatic Cancer

Patients scheduled for surgery due to pancreatic adenocarcinoma exhibited similar pathologic and surgical outcomes when treated with stereotactic body radiation therapy (SBRT) compared to those receiving conventionally fractionated chemoradiation therapy, as reported in the phase II SOFT Preop study presented at the 2026 American Society for Radiation Oncology (ASTRO) Annual Meeting.

Study Overview

The trial aimed to determine the optimal type of neoadjuvant therapy for patients with pancreatic cancer, highlighting the increasing utilization of such treatments. Neoadjuvant radiation options include extended courses spanning weeks or focused SBRT delivered in five sessions. This study, led by William A. Hall, MD, explored these two approaches through a randomized trial framework for the first time.

The SOFT Preop trial enrolled 102 patients with resectable, borderline resectable, or locally advanced pancreatic ductal adenocarcinoma who met specific criteria, including an Eastern Cooperative Oncology Group performance status score of 0 to 2. All participants had undergone at least one month of neoadjuvant chemotherapy, with 92% receiving over two months.

Participants were assigned in a 1:1 ratio to receive either SBRT (25 Gy in 5 fractions for regional nodes and 33 to 35 Gy in 5 fractions for the primary tumor) or conventional chemoradiation (50.4 Gy in 28 fractions, supplemented by weekly gemcitabine or capecitabine). Most treatments utilized 1.5-T adaptive MRI guidance, marking a significant differentiation from earlier studies employing SBRT alone.

Outcomes

The primary endpoint, pathologic lymph node positivity, was assessed at surgical resection. Among the 83 patients who completed treatment, lymph node positivity rates were 41% in the SBRT group and 38% in the conventional therapy group (P = .754), revealing similar results across both arms. Additionally, no significant differences were found in surgical complications or margin-negative resections.

Local and regional recurrences emerged infrequently during a median follow-up of 3.4 years, noting an overall recurrence rate of 7.8% and equivalent progression-free survival (P = .96) and overall survival rates (P = .639). Dr. Hall remarked on the surprising nature of these survival findings, underscoring the need for continued patient monitoring.

Quality of Life Improvements

Significantly, the study found that patients undergoing SBRT reported better quality of life during treatment, notably in areas such as physical function and fatigue, due to the reduced treatment frequency compared to the conventional method (P < .05). This quality-of-life advantage emphasizes the potential for SBRT to enhance patient experience in a demanding treatment landscape.

Dr. Hall concluded by noting that while many questions regarding neoadjuvant radiation therapy remain, the trial results support the integration of a five-treatment SBRT regimen into clinical discussions, particularly considering its benefits in preserving quality of life for patients during crucial treatment periods.

Disclosure

Dr. Hall has disclosed receiving grant support from Elekta and compensation from Aktis Oncology and Sonoptima. Dr. Chang reported no conflicts of interest.

Reference

1. Hall WA, Tsai S, Banerjee A, et al. A randomized, phase II clinical trial of stereotactic body radiation therapy or conventionally fractionated concurrent chemotherapy and radiation therapy preoperatively for pancreatic adenocarcinoma, the SOFT Preop study. 2026 ASTRO Annual Meeting. Abstract LBA 08.