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The following is a summary of “Quality of life and toxicity in patients with pancreatic ductal adenocarcinoma treated with online adaptive stereotactic MR-guided radiotherapy,” published in the April 2025 issue of International Journal of Radiation Oncology, Biology, Physics by Westerhoff et al. 

Online adaptive magnetic resonance-guided radiotherapy (MRgRT) utilizing a hybrid 1.5T MRI-linear accelerator (MR-Linac) platform offers a promising approach for delivering high-precision, stereotactic ablative doses to pancreatic tumors. This study aimed to evaluate both patient-reported quality of life (QoL) outcomes and clinician-reported toxicity in individuals with non-metastatic pancreatic ductal adenocarcinoma (PDAC) treated with stereotactic MRgRT. Patients included in the analysis were identified from the international, prospective observational XXX study and had undergone treatment between May 2019 and December 2023 across eight participating centers, in accordance with local standard protocols. QoL was assessed using the EORTC QLQ-C30 questionnaire, while toxicity data were collected using the Common Terminology Criteria for Adverse Events (CTCAE) at baseline and at 3, 6, and 12 months post-treatment. 

Patients who underwent surgical resection or initiated systemic therapy during follow-up were censored, and a sensitivity analysis further excluded those who experienced disease progression. A linear mixed model was employed to evaluate mean differences in QoL scores from baseline, with clinical relevance defined as a mean difference of 10 or more points and statistical significance set at p ≤ 0.05. Among the 127 patients included, treatment doses ranged from 30 to 50 Gy delivered over five fractions. Functional QoL domains, including global health status and role functioning, remained stable across the follow-up period. Notably, there was a statistically significant and clinically meaningful improvement in nausea and vomiting at 6 months (MD -10, 95% CI -17 to -3; p < 0.001). In the sensitivity analysis, further improvements were observed in both nausea and vomiting (MD -11, 95% CI -18 to -3; p < 0.001) and appetite loss (MD -14, 95% CI -28 to 0; p = 0.05). No other QoL domains showed significant deterioration. 

Regarding safety, acute grade 3 toxicity was reported in 2 patients, and late grade 3 toxicity occurred in 1 patient, indicating a low incidence of severe adverse effects. These findings suggest that stereotactic MRgRT in patients with non-metastatic PDAC is well-tolerated, preserves overall functional status, and provides symptomatic relief with minimal high-grade toxicity for up to 12 months following treatment.

Source: redjournal.org/article/S0360-3016(25)00307-4/abstract