Copyright: ©Author(s) 2026.
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
Table 1 Patients baseline characteristics, n (%)
| Characteristics | |
| Number of patients | 24 |
| Sex | |
| Women | 11 (46) |
| Men | 13 (54) |
| Age, median age (range) | 65 (49-84) |
| Age > 75 | 4 (17) |
| ECOG score | |
| 0 | 11 (46) |
| 1 | 11 (46) |
| 2 | 2 (8) |
| Location of primary tumor | |
| Head | 10 (42) |
| Body | 3 (13) |
| Tail | 2 (8) |
| Head/body | 2 (8) |
| Body-tail | 2 (8) |
| Local relapse | 5 (21) |
| Onset of metastatic state | |
| Synchronous | 13 (54) |
| Metachronous | 11 (46) |
| Number of metastases | |
| ≤ 5 metastases | 14 (58) |
| > 5 metastases | 10 (42) |
| Location of metastases | |
| Liver only | 12 (50) |
| Lung only | 4 (17) |
| Non-regional lymph nodes only | 2 (8) |
| Peritoneal carcinomatosis | 4 (17) |
| Multiple organs | 2 (8) |
| Median CA19.9 at diagnosis of metastatic disease (range) | 365 UI/mL (17-2697) |
| Median CA19.9 before MRgRT (range) | 132 UI/mL (10.5-2120) |
Table 2 Indication for magnetic resonance-guided radiotherapy administration
| Primary tumor | |||
| Stable | Progressive | ||
| Extrapancreatic sites | Stable | Consolidative treatment (n = 9; 38%) | Local control: For isolated primary progression (n = 5; 21%) |
| Progressive | Metastasis- and primary-directed therapy: Treatment of all macroscopic tumor sites (n = 3; 13%) | Palliative treatment: In case of chemotherapy intolerance or for pain relief (n = 7; 29%) | |
Table 3 Treatment characteristics, n (%)
| Treatment characteristics | |
| Chemotherapy preceding MRgRT | |
| Number of patients received chemotherapy | 22 (92) |
| Median duration of chemotherapy (months) | 7 |
| Median number of cycles | 12 cycles |
| (m)FOLFIRINOX | 16 (67) |
| Gem/nabPac | 4 (17) |
| Liposomal irinotecan + 5-FU and folinic acid (NAPOLI) | 2 (8) |
| No chemotherapy | 2 (8) |
| Radiotherapy | |
| Median total dose, Gy (range) | 33 (33-40) |
| 33 Gy/SIB 40 Gy | 11 (46) |
| 33 Gy | 13 (54) |
| Gross tumor volume, median range (cc) | 44 (12-101) |
| Clinical target volume, median range (cc) | 214 (81-583) |
| Optimized planning target volume, median range (cc) | 248 (65-662) |
| Metastasis-directed therapy | 4 (17) |
| SBRT or brachytherapy | 3 (13) |
| Resection of liver metastasis | 1 (4) |
| Post-RT chemotherapy | 19 (83) |
Table 4 Key studies investigating stereotactic body radiotherapy as primary-directed therapy in metastatic pancreatic ductal adenocarcinoma
| Ref. | Study design | Patient population | Metastatic sites | Induction CTx | SBRT treatment | Dose | Overall survival | Local control | Toxicity |
| Su et al[24], 2015 | Retrospective single-center analysis | 16 mPDAC, 9 LAPC patients | NR | 2/25 patients gemcitabine-based CTx | PDT | 30-36 Gy/3 Fx; 40-48 Gy/4 Fx | Median: 9 months (mPDAC) | NR | Acute: 0% G ≥ 3; late: NR |
| Gkika et al[29], 2017 | Retrospective single-center analysis | 18 recurrent and omPDAC patients | Liver, lymph nodes | NR | PDT/MDT/combinations | PDT: Median BED10 67 Gy; MDT: NR | Median: 13 months, 6-/12-month: 87%/58% | 6-/12-month freedom from local progression 93%/67% | Acute: 5% G ≥ 3; late 5% G ≥ 3 |
| Lischalk et al[30], 2018 | Retrospective single-center analysis | 20 synchronous mPDAC patients | NR | Gemcitabine-based (20%), FOLFOX (15%), FOLFIRINOX (10%), FOLFIRI (5%), other (10%) | PDT | Median 30 Gy/5 Fx | Median: 14 months, 12-month: 53% | Median local control: 7 months; 12-month LC: 43% | Acute: NR; late: 0% |
| Koong et al[31], 2020 | Retrospective single-center analysis | 27 omPDAC patients (≤ 3 metastases, ≤ 2 organs) | Liver, lung, peritoneum, other | 89% at least one cycle prior to SBRT, predominantly gemcitabine-based | PDT | Single Fx (63%) median 25 Gy; 5 Fx (37%): Median 33 Gy | Median: 7 months, 12-month: 53% | 12-month local failure rate: 25% | Acute or late 7% |
| Ji et al[23], 2021 | Retrospective single-center propensity score matched analysis | 34 synchronous omPDAC patients (≤ 5 metastases) vs 59 patients treated with CTx alone | Liver | Predominantly gemcitabine-based (98%) | PDT | Median 42.5 Gy in 5-7 Fx | Median: 9 months (PDT + CTx) vs 8 months (CTx), 12-month: 40% vs 21% | 12-month cumulative incidence of local progression: 22% (SBRT + CTx) vs 53% (CTx) (P = 0.016) | 4% G3 |
| Elamir et al[37], 2022 | Retrospective single-center analysis | 6 synchronous and 14 metachronous omPDAC patients (≤ 5 metastases) vs 21 patients treated with CTx alone | Liver, lung | 90% (predominantly gemcitabine/nab-paclitaxel and FOLFIRINOX) | PDT (25%)/MDT (100%) | PDT: Median 40 Gy/5 Fx; MDT: Median 50 Gy/5 Fx | Median: 42 months (SBRT + CTx) vs 18 months (CTx) from omPDAC diagnosis | Median local control: Not reached; 12-/24-month local control: 92%/83% | NR |
| Webking et al[13], 2023 | Retrospective bi-institutional analysis | 22 synchronous or metachronous omPDAC patients (≤ 6 metastases) | Liver, lung, lymph nodes, bones | FOLFIRINOX (64%) gemcitabine/nab-paclitaxel (36%) | PDT (MRgRT) + MDT (41%) | PDT: Median 50 Gy/5 Fx; MDT: NR | Median from diagnosis: 24 months; median from SBRT: 12 months | FFLRF: Median 12 months | 9% G3 |
| Ludmir et al[38], 2024 (EXTEND) | Randomized phase 2 multicenter trial [CTx vs CTx + MDT (+ PDT)] | 40 synchronous (35%), metachronous (65%) omPDAC patients (≤ 5 metastases) | Liver, lung, lymph node, bone, other sites | 73% (predominantly FOLFIRINOX or nab-paclitaxel-based CTx) | SBRT to all active sites (11 Pat with PDT in experimental arm) | PDT: Median 40 Gy/5 Fx; MDT: Predominantly 50 Gy/4 Fx or 70 Gy/10 Fx | Median 12 months (CTx + SBRT) vs 10 months (CTx) (P = 0.24) | NR; median PFS 10 months vs 3 months (P = 0.03) | 16% G3 (all classified as not related to SBRT) |
| Jiang et al[28], 2024 | retrospective comparison PDT vs PDT + MDT | 217 synchronous omPDAC patients (≤ 5 metastases) | Liver, lung, bone, other sites | 100% adjuvant CTx (predominantly gemcitabine/nab-paclitaxel and FOLFIRINOX) | PDT (n = 158) vs PDT + MDT (n = 59) | PDT: Median BED 60 Gy (30-45 Gy/5-8 Fx); MDT: Median BED 93 Gy (40-64 Gy/5-8 Fx) | Median 11 months (PDT + MDT) vs 9 months (PDT) (P < 0.001); 12-month: 37% vs 3% | NR; median PFS: 7 months vs 4 months (P < 0.001) | G3/4: 24% vs 20% |
| Schumann et al (current study), 2026 | Prospective single-center observational study | 24 synchronous (54%) and metachronous (46%) mPDAC patients | Liver, lung, lymph nodes, peritoneal carcinomatosis | 92% (predominantly FOLFIRINOX or nab-paclitaxel-based CTx) | PDT (MRgRT) + MDT (13%) | PDT: 33 Gy (54%) or 40 Gy (46%) in 5 Fx; MDT: Median BED | Median: 13 months; 12-month: 49% | 12-/24-month local control: 76%/67% | Acute: 5% G ≥ 3; late 5% G ≥ 3 |
- Citation: Schumann MA, Gaasch A, Boyaci S, Fuchs F, Walter F, Marschner SN, Eze C, Westphalen CB, Holch JW, Beyer G, Kunz WG, Mayerle J, Niyazi M, Belka C, Corradini S, Rogowski P. Five-fraction stereotactic magnetic resonance-guided adaptive radiotherapy targeting the primary tumor in metastatic pancreatic cancer. World J Gastroenterol 2026; 32(29): 117832
- URL: https://www.wjgnet.com/1007-9327/full/v32/i29/117832.htm
- DOI: https://dx.doi.org/10.3748/wjg.117832