Patients preparing for pancreatic cancer surgery kept better physical function and reported less fatigue when they received five sessions of focused radiation instead of 28 sessions of radiation with chemotherapy, according to a randomized trial presented Sept. 28 at the American Society for Radiation Oncology annual meeting in Boston.
Survival told a more cautious story. Patients in the short-course group had lower median survival figures, although the differences were not statistically significant and the trial was too small to answer that question. For patients and families weighing treatment, both findings belong in the same conversation.
Fewer Visits, Less Fatigue in the SOFT Preop Trial
The SOFT Preop study, led by William A. Hall, M.D., chair of radiation oncology at the Medical College of Wisconsin in Milwaukee, enrolled 102 patients whose pancreatic cancer had not spread to distant organs and might be removed surgically. All had already received at least a month of chemotherapy, and most had received more than two months.
Patients were randomly assigned to stereotactic body radiation therapy, or SBRT, delivered in five treatments, or to conventional radiation given with chemotherapy over 28 treatments. Both approaches targeted the tumor and nearby high-risk lymph nodes, and surgery was planned four to six weeks later.
Patients in the SBRT group reported significantly better physical function and overall physical health, with less fatigue, before surgery. That advantage faded after surgery. "For patients with pancreatic cancer who have already spent months receiving chemotherapy and are preparing for major surgery, reducing the amount of time spent in radiation treatment matters," Hall said.
The trial's main measure, cancer remaining in lymph nodes at surgery, was similar. Among 83 patients who completed treatment and surgery, 41% of the SBRT group and 38% of the chemoradiation group still had cancer in their lymph nodes. Complication rates, tumor response, and surgical margins also did not differ significantly.
The Survival Gap and the Reasons It Remains Unsettled
Median overall survival from enrollment was 26 months with SBRT and 43 months with chemoradiation. At three years, 43% of the SBRT group and 58% of the chemoradiation group were alive. Median progression-free survival was about 14 months and 22 months, respectively. Over a median follow-up of about 3.4 years, cancer returned near the pancreas in six SBRT patients and two chemoradiation patients. Among patients who completed all therapy, including surgery, median survival was 39.6 months with SBRT and 45.5 months with chemoradiation.
None of these differences reached statistical significance, and the trial was not designed with enough patients to detect survival differences. In a study of about 100 people, a handful of outcomes can move medians substantially. Still, a gap of this size is not something patients should dismiss, and it is exactly why larger trials are needed.
Other limits matter too. This was a single-institution Phase 2 trial run by an experienced pancreatic cancer team, so results may differ elsewhere. Because patients enrolled after initial chemotherapy, survival was measured from enrollment rather than from diagnosis.
Daniel Chang, M.D., who chairs ASTRO's pancreatic cancer guideline and practices at the University of Michigan, noted that "SBRT did not increase surgical complications, an often-cited concern." The findings do not change standard guidance on their own.
Hall argued that local control will matter more as drug treatments improve. "If you want to cure these patients, they simply cannot recur locally," he said. "The next step is to build on these findings in larger studies."
Treatment Decisions for Patients and Caregivers
Pancreatic cancer remains among the deadliest cancers. The American Cancer Society estimates that about 67,530 Americans will be diagnosed in 2026 and about 52,740 will die of the disease. For the minority whose cancer can be removed surgically, every step before the operation affects strength, recovery, and family routines.
Daily radiation for several weeks can mean repeated trips, missed work for caregivers, and added fatigue at a time when patients need to stay strong enough for major surgery. A five-visit schedule could ease that burden, but patients should weigh it against the uncertain survival picture rather than choose it for convenience alone. The National Cancer Institute explains how chemoradiation and other pancreatic cancer treatments are used.
Useful questions for a care team include whether radiation is recommended at all in a patient's situation, which schedule the team suggests and why, how much experience the center has with SBRT for pancreatic cancer, and whether a clinical trial is available. A recent MedicalDaily report found that time from diagnosis to treatment has grown, so asking early about scheduling also matters.
Patients should seek prompt care for yellowing skin or eyes, fever, severe abdominal pain, persistent vomiting, or signs of dehydration during treatment. No one should change a planned treatment without discussing it with their oncology team.
Key Questions Answered
What did the trial compare? Five sessions of SBRT versus 28 sessions of radiation with chemotherapy before pancreatic cancer surgery.
What was the benefit of SBRT? Better physical function and less fatigue during treatment, with similar lymph node and surgical results.
Was survival different? Median survival was lower with SBRT, but the differences were not statistically significant, and the trial was not designed to test survival.
Who took part? 102 patients with non-metastatic pancreatic cancer who had already received chemotherapy.
Does this change standard care? Not yet. Larger multicenter trials are needed.
What should patients ask? Whether radiation is recommended, which schedule fits, and how experienced the center is with SBRT.
Published by Medicaldaily.com
