Systematic review: Stereotactic Body Radiation Therapy for Pancreatic Cancer: Evaluating its Efficacy, Safety, and Future Prospects
In brief
SBRT yields 82% one-year local control and low severe toxicity
In a review of 35 studies of locally advanced pancreatic cancer, stereotactic body radiation therapy achieved pooled one-year local control of about 82% while grade 3 or higher acute and late toxicities occurred in only 3% and 2% of patients, respectively. Higher radiation doses and adaptive MRI-guided or particle techniques improved precision, but distant disease progression remains the dominant cause of failure, highlighting the need for combined systemic approaches.
- Journal
- The British journal of radiology (Q1)
- Published
- 24 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Biplab Sarkar
- PMID
- 42635528
- DOI
- 10.1093/bjr/tqag198
Why clinicians should know about it
- Picked for Medical Physics (top studies of the week, 30 August 2026): SBRT review focusing on clinical outcomes
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (top studies of the week, 30 August 2026): Systematic review of SBRT for pancreatic cancer
Abstract
AIM: This systematic narrative review evaluates the efficacy, safety, and future potential of Stereotactic Body Radiation Therapy (SBRT) in locally advanced pancreatic cancer (LAPC), particularly for patients unsuitable for surgery. METHODS: A systematic search of PubMed, Embase, and the Cochrane Library identified English and select non-English studies published between January 2010 and November 2025. Search terms included "pancreatic cancer," "SBRT," "locally advanced pancreatic cancer," "adaptive radiotherapy," "proton therapy," "toxicity," and "outcomes." Eligible peer-reviewed studies (clinical trials, cohort studies, systematic reviews; ≥20 patients) reporting local control (LC), overall survival (OS), progression-free survival (PFS), and toxicity were included. Study quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. Owing to heterogeneity, narrative synthesis was performed, supplemented by pooled estimates from recent meta-analyses following PRISMA guidelines. RESULTS: Thirty-five studies were included (25 photon SBRT, 6 proton, 4 carbon-ion). One-year LC ranged 70-95% (pooled 82%); median OS 13-20 months (pooled 16.8 months). Higher BED₁₀ (>70 Gy) improved LC (HR 0.68). Grade ≥3 acute toxicity was 3%, and late gastrointestinal toxicity 2%. Adaptive MRI-guided SBRT reduced margins (2-3 mm) and toxicity (∼40%) while maintaining >90% LC. Proton therapy achieved mOS 19.5months; carbon-ion therapy reported 95% 1-year LC. Distant progression (60%) predominated. CONCLUSION: SBRT provides high local control with acceptable toxicity in LAPC. Advanced adaptive and particle techniques enhance precision, but systemic progression remains the main challenge, underscoring the need for multimodal strategies and large randomized trials. ADVANCES IN KNOWLEDGE: This article summarizes the efficacy of SBRT in LAPC.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.