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Life sciences · Journal article
Radiotherapy and Oncology · October 1, 2026
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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.