Preoperative SBRT Shows High Resection Rates in Pancreatic Adenocarcinoma

In an interview with CancerNetwork® at the 2026 American Society for Radiation Oncology (ASTRO) Annual Meeting, William A. Hall, MD, professor and chair of radiation oncology at the Medical College of Wisconsin and medical director of Froedtert Radiation Oncology, reviewed surgical outcomes from the phase 2 SOFT Preop study (NCT03704662), which randomly assigned patients with pancreatic adenocarcinoma to preoperative stereotactic body radiation therapy (SBRT) or conventionally fractionated chemoradiation.

Of 98 evaluable patients, 83 proceeded to surgery, and R0 resection rates exceeded 80% in both arms. Hall noted that there were no differences in surgical complications, toxicity, or surgeon-reported intraoperative complexity and fibrosis, which gives his group confidence in SBRT as a neoadjuvant platform. He credited the high resection rates to close multidisciplinary collaboration within the LaBahn Pancreatic Cancer Program and stressed the importance of treatment at high-volume centers. He also described the SBRT approach, which included an elective nodal dose of 25 Gy in 5 fractions with a simultaneous tumor boost to 33 to 35 Gy.

Transcript:

Hall: R0 resection [rates] were very high for both approaches, well over 80%, which is impressive. The other thing to note is that the majority of patients went to surgery. We enrolled 102 patients, and 4 patients withdrew, so we had 98 who were available for the analysis. Of those 98, 83 went to surgery. That’s a high rate of surgical resection, and it speaks volumes to the expertise of the surgeons in our program. We have amazing surgical oncologists. They’re wonderful to work with, very multidisciplinary, and very supportive of and open-minded to radiation and new ways of treating patients with pancreatic cancer. We work very closely together. We meet every week and review all the patients closely, and that contributed to the high rates of surgical resection. These rates were much higher than in other trials that have tested SBRT in the neoadjuvant setting.

It speaks to a couple of important elements. Number one, patients who have pancreatic cancer need to go to a high-volume center. They need to take the time to find a qualified team that has a deep breadth of experience treating pancreatic cancer. That’s something we do daily and weekly at the Medical College of Wisconsin and the LaBahn Pancreatic Cancer Program. We have an incredible amount of expertise in treating pancreatic cancer, and it’s clear that makes a big difference. When patients come in with pancreatic cancer and we review them as a multidisciplinary team, the vast majority of the time, if they are surgical candidates, they end up going to surgery, which is a wonderful thing.

The other thing to note is that there were no differences in surgical complications. When we started the study, we didn’t know if there would be more complications associated with giving SBRT preoperatively. That had not been studied robustly in a prospective randomized trial compared with more traditional, conventionally fractionated radiation schedules, so we just didn’t know what the toxicity was going to look like. We saw no differences in surgical complications or toxicity. We also collected surgical perspectives on intraoperative complexity, fibrotic findings, and the difficulty of the surgical procedure, and we didn’t see any differences there either. That gives us a lot of confidence in building on SBRT as a neoadjuvant platform.

The other thing to note is that we did SBRT using slightly different volumes, and a lot of that detail will be in the presentation as well as in the manuscript. We used a low-dose [clinical target volume] to cover regional nodes. For example, we treated [the celiac axis, the superior mesenteric artery, and the superior mesenteric vein]. There’s a common region called the triangle region, which has been published by a group at Johns Hopkins looking at high-risk areas of recurrence. We treated all those areas with 25 Gy in 5 fractions as a preventative dose on the SBRT arm, and then we simultaneously boosted the tumor to the mid-30s, so 33 Gy to 35 Gy. The surgical outcomes were essentially identical in both cohorts. Margin negativity rates were extremely similar.

Reference

Hall WA, Tsai S, Banerjee A, et al. A randomized, phase II clinical trial of stereotactic body radiation therapy or conventionally fractionated concurrent chemotherapy and radiation therapy preoperatively for pancreatic adenocarcinoma, the SOFT Preop study. Presented at: 2026 ASTRO Annual Meeting; September 26–30, 2026; Boston, MA. Abstract LBA 08.