Stereotactic MRI-guided adaptive radiation therapy (SMART) for locally advanced pancreatic cancer: A prospective single-center cohort study
In brief
MRI-guided radiation saw local progression in 15% at one year
In this prospective, single-center cohort of 118 patients with locally advanced pancreatic cancer, 15% had local progression by one year after MRI-guided adaptive radiation; severe acute gastrointestinal toxicity occurred in 5.4% of those assessed. Distant progression remained the dominant pattern of failure, and without a comparison group, the study cannot show whether this approach improves survival or control over other treatments.
- Journal
- Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology (Q1)
- Published
- 1 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Pia Braagaard Hartfelt, Anne L H Bisgaard, Mathilde Weisz Ejlsmark, Rana Bahij, Tine Schytte, Faisal Mahmood, et al.
- PMID
- 42822782
- DOI
- 10.1016/j.radonc.2026.111790
Why clinicians should know about it
- Picked for Radiation Oncology (paper of the day, 2 October 2026): SMART MRI-guided adaptive radiation for pancreatic cancer
Abstract
PURPOSE: This prospective single-center cohort study evaluated outcomes and toxicity after ablative stereotactic magnetic resonance imaging (MRI)-guided adaptive radiation therapy (SMART) in patients with locally advanced pancreatic cancer (LAPC). MATERIALS AND METHODS: Patients with LAPC treated within the MOMENTUM protocol (NCT04075305) received SMART (50 Gy/5 fractions) on a 1.5 T MRI-linear accelerator. Data were prospectively collected. Overall survival (OS), progression-free survival (PFS), risk of local progression, and toxicity were evaluated. RESULTS: Between February 2019 and September 2025, 118 patients with LAPC were treated. Median OS from the first SMART fraction was 13.2 months (95 % confidence interval [CI] 10.4-15.9), with a 2-year OS rate of 23.9 % (95 % CI 16.7-34.1). Median OS from diagnosis was 19.6 months (95 % CI 17.8-24.0). Median PFS from the first SMART fraction was 5.6 months (95 % CI 4.3-7.1), and 2-year PFS was 14.8 % (95 % CI 8.8-24.9 %). The cumulative incidence of local progression was 15.0 % at 1 year and 22.2 % at 2 years. Acute grade ≥ III gastrointestinal toxicity occurred in 6/112 assessed patients (5.4 %), including one grade IV ulcer perforation and one grade V duodenal perforation. Late grade ≥ III toxicity occurred in 3/93 assessed patients (3.2 %). CONCLUSION: SMART provided encouraging local control with limited severe toxicity in patients with LAPC, while distant progression remained the dominant pattern of failure.
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.