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For pancreatic cancer patients heading into surgery, SBRT offers a more convenient, better-tolerated treatment with quality-of-life perks — but a small randomized trial hints that conventional chemoradiation may have a survival edge. The phase 2 SOFT Preop trial found no difference in lymph node positivity or surgical complications between the two approaches. Researchers say the survival gap is noteworthy but the trial wasn't powered to draw firm conclusions.
For patients with resectable or locally advanced pancreatic ductal adenocarcinoma (PDAC), choosing the right pre-surgery radiation strategy is a real dilemma. The phase 2 SOFT Preop trial tackled this head-on by randomly assigning 98 patients to either stereotactic body radiotherapy (SBRT — just 5 sessions) or conventional chemoradiation (28 sessions with chemotherapy). The results? A mixed bag.
On the reassuring side, both approaches produced similar rates of lymph node positivity, pathologic response, and surgical complications. Patients receiving SBRT also reported significantly better physical function, global health scores, and less fatigue before surgery — a meaningful win for a grueling treatment journey.
The wrinkle: median overall survival was numerically shorter with SBRT (26 vs. 43 months), though the trial wasn't powered to detect survival differences. Among patients who completed treatment, the gap narrowed considerably (39.6 vs. 45.5 months).
By the Numbers:
Why it matters: SBRT's convenience and tolerability make it an attractive option, but the numerical survival signal — even if statistically inconclusive — warrants attention. Researchers are calling for larger trials to settle the question definitively.
