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Pancreatic cancer is a debilitating cancer with unfavourable survival rates compared to other cancers. Survival rates of patients with inoperable pancreatic cancer is typically short where the length of time between diagnosis and death is usually less than 6 months. The overall survival at 1 year is approximately 20% and at 5 years is approximately 5%(Goldsmith et al, 2018). In clinical practice, patients with inoperable pancreatic cancer are often treated with conventional fractionated chemo-radiotherapy which is protracted and associated with a poor toxicity profile.  At present Stereotactic Ablative Body Radiotherapy (SABR) is being used with increasing frequency and has shown favourable clinical results. This study looks at the efficacy of SABR within this patient cohort in terms of overall survival (OS) and post radiotherapy (RT) toxicity.

A retrospective review of all patients with pancreatic cancer (T1-3N0M0) who were treated with a dedicated robotic stereotactic RT machine at our institution was conducted. All patients were treated under free breathing with real time motion tracking image guided RT. The OS was calculated using Kaplan-Meier method and the post RT toxicity data was scored following the CTCAE v4.0 protocol. Assuming α/β=10 for tumour control, the biological equivalent doses (BED) of prescribed treatment were calculated. For subgroup analysis of prognostic factors, medians were used to catergorise patients into 2 groups: ≤median and >median. A Mantel-Cox log rank analysis was used to assess OS between these groups

Between July 2011 to July 2022, 44 patients with inoperable pancreatic cancer who received SABR (either 3 or 5 fractions) at our institution were included in this study. The median follow-up was 9.6 months (range 1.0-34.2). 80% of the patients received chemotherapy prior to SABR and none of them were treated with concurrent chemotherapy during SABR.


The median OS was 9.2 months (95% CI5.9-12.5) and the OS at 12 months was 35%. Acute and late toxicities from stereotactic treatment include fatigue, nausea and bowel disturbance. 50% of patients reported grade 1 and grade 2 fatigue within 12 months post completion of RT. No greater than grade 3 post RT toxicity has been reported in this cohort.


No statistically significant differences in OS were found when comparing the median groups of patients’ ages, number of fractions, chemotherapy prior SABR status, BED, gross tumour volume (GTV) and planning target volume (PTV) s (p>0.05 of all factors).

The use of SABR in our cohort of patients with inoperable pancreatic cancer has shown promising OS rates irrespective of patients’ ages, number of fractions, prior chemotherapy status, BED, GTV and PTV sizes, with excellent post RT toxicity profile.