When is SBRT appropriate as neoadjuvant treatment for resectable pancreatic cancer?

Radiation therapy for operable pancreatic cancer minimizes local recurrence and maximizes the rate of tumor response. To cure patients with pancreatic cancer, the tumor cannot recur locally. New ways of giving radiation can be efficient and well tolerated. The optimal radiation sequencing (with systemic therapy), dose, dose rate, modality, and fractionation schedule have yet to be determined. The next five years of research in pancreatic cancer will need to shift toward understanding how radiati...

The results of the SOFT trial show that SBRT is an appropriate preoperative radiation regimen for patients receiving preoperative therapy for pancreatic cancer. It has been used in the preoperative setting in retrospective and prospective studies for borderline resectable disease, and the SOFT trial confirms that it is safe and does not increase the risk of surgical complications. In addition, SBRT preserved quality of life better than conventional chemoradiation during treatment, which is an un...

Off trial, do you sequence modalities as per SOFT? I.e., chemo first, then RT then, 4-6 weeks later, surgery. It's not the sequencing I would advocate for rectal cancer, but for pancreatic cancer, putting chemo upfront makes sense because of the high risk of rapid dissemination.