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World J Gastroenterol. Aug 7, 2026; 32(29): 117832
Published online Aug 7, 2026. doi: 10.3748/wjg.117832
Published online Aug 7, 2026. doi: 10.3748/wjg.117832
Five-fraction stereotactic magnetic resonance-guided adaptive radiotherapy targeting the primary tumor in metastatic pancreatic cancer
Mohamed A Schumann, Aurélie Gaasch, Sandra Boyaci, Frederik Fuchs, Franziska Walter, Sebastian N Marschner, Chukwuka Eze, Maximilian Niyazi, Claus Belka, Stefanie Corradini, Paul Rogowski, Department of Radiation Oncology, LMU University Hospital, Munich 81377, Germany
Mohamed A Schumann, Claus Belka, Bavarian Cancer Research Center (BZKF), Partner Site Munich, Munich 81377, Germany
Sebastian N Marschner, Julian Walter Holch, Claus Belka, German Cancer Consortium (DKTK), Partner Site Munich, Munich 81377, Germany
Christoph Benedikt Westphalen, Julian Walter Holch, Department of Medicine III, LMU University Hospital, Munich 81377, Germany
Georg Beyer, Julia Mayerle, Department of Medicine II, LMU University Hospital, Munich 81377, Germany
Wolfgang G Kunz, Department of Radiology, LMU University Hospital, Munich 81377, Germany
Maximilian Niyazi, Department of Radiation Oncology, University Hospital Tübingen, Tübingen 72076, Germany
Maximilian Niyazi, German Cancer Consortium (DKTK), Partner Site Tübingen, Tübingen 72076, Germany
Stefanie Corradini, Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen 91054, Germany
Author contributions: Schumann MA and Rogowski P designed and conducted the study and wrote the paper; Gaasch A and Boyaci S contributed to the analysis; Fuchs F, Walter F, Marschner SN, Eze C, Westphalen CB, Holch JW, Beyer G, Kunz WG, and Mayerle J provided clinical advice and revised the manuscript; Niyazi M, Belka C, Corradini S, and Rogowski P supervised the study.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Ludwig-Maximilians-University Hospital Munich (reference number: 20-0291).
Informed consent statement: All patients have signed informed consent to the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at
Corresponding author: Mohamed A Schumann, Department of Radiation Oncology, LMU University Hospital, Marchioninistrasse 15, Munich 81377, Germany.
Received: December 18, 2025
Revised: January 27, 2026
Accepted: April 14, 2026
Published online: August 7, 2026
Processing time: 210 Days and 21.9 Hours
Revised: January 27, 2026
Accepted: April 14, 2026
Published online: August 7, 2026
Processing time: 210 Days and 21.9 Hours
Core Tip
Core Tip: Local progression of the primary tumor remains a major cause of morbidity in metastatic pancreatic ductal adenocarcinoma, even in the era of modern chemotherapy. This prospective observational study demonstrates that five-fraction stereotactic magnetic resonance-guided radiotherapy to the primary tumor is feasible and safe in patients with metastatic pancreatic ductal adenocarcinoma, achieving good local control, meaningful pain palliation, and low rates of high-grade toxicity. These findings support magnetic resonance-guided radiotherapy as a promising local treatment option within multimodal strategies for carefully selected patients with controlled metastatic disease.