Stereotactic Body Radiation Therapy for Locally Advanced Pancreatic Adenocarcinoma: A Systematic Review and Meta-Analysis of Prospective Trials.
K Liang Zeng, Alexander V Louie, Rupesh Kotecha et al.
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In 30 seconds
This systematic review and meta-analysis assessed prospective trials of definitive stereotactic body radiation therapy (SBRT, up to 6 fractions) for locally advanced or unresectable pancreatic cancer. Across 23 studies involving 901 patients, pooled local control was 82% at 12 months and 70% at 24 months; pooled 12-month overall survival was 63%. The pooled risk of grade 3–4 toxicity was 2%, while grade 5 toxicity was 0.2% (7 events), mostly gastrointestinal bleeding. The authors concluded that modern techniques can deliver high doses with durable local control and low rates of severe toxicity.
Key findings
- Pooled local control was 82% at 12 months and 70% at 24 months.
- Pooled overall survival was 63% at 12 months and 28% at 24 months; progression-free survival was 35% and 15%, respectively.
- The pooled risk of grade 3–4 toxicity was 2%; grade 5 toxicity was 0.2% (7 events), mostly gastrointestinal bleeding.
- On univariable metaregression, higher biologically effective dose was associated with improved 24-month local control and overall survival.
Why it matters
For locally advanced pancreatic cancer, durable local control must be weighed against treatment toxicity and limited survival. This synthesis of prospective trials provides pooled estimates for control, survival, and severe adverse events, helping frame the potential benefits and risks of SBRT. Associations between treatment characteristics and outcomes may inform interpretation of the evidence but do not establish that those characteristics cause better outcomes.
What to keep in mind
The analysis pooled prospective trials rather than reporting a single randomised comparison; metaregression findings were univariable and therefore show associations, not causal effects.