Pancreatic SBRT in Italian Clinical Practice: A Multicenter Analysis of 473 Patients Treated in 17 Centers
18 affiliations
- 1Radiation Oncology Unit, IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- 2Department of Advanced Radiotherapy Oncology, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar Oncology Care Center, 37024 Verona, Italy
- 3Radiation Oncology Unit, Verona University Hospital, 37126 Verona, Italy
- 4Department of Diagnostic Imaging and Oncological Radiotherapy, Agostino Gemelli University Hospital Foundation, IRCCS, 00168 Rome, Italy
- 5Radiation Oncology Unit, Parini Hospital, 11100 Aosta, Italy
- 6Department of Medicine and Surgery, LUM University, Casamassima, 70010 Bari, Italy
- 7Proton Therapy Unit, Department of Medical Specialties, New Trentino Hospital Center, 38122 Trento, Italy
- 8Department of Translational Medicine (DIMET), University of Eastern Piedmont, 13100 Novara, Italy
- 9Radiotherapy Unit, Pisa University Hospital, Via Roma 69, 56120 Pisa, Italy
- 10Department of Radiation Oncology, Ospedale SS. Annunziata, 66100 Chieti, Italy
- 11Radiation Oncology, University Hospital of the Marche, 60126 Ancona, Italy
- 12Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy
- 13Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- 14Radiotherapy Unit, Department of Radiological Sciences, Azienda Sanitaria Territoriale Pesaro-Urbino, 61122 Pesaro, Italy
- 15Radiation Oncology, San Martino Hospital, AULSS1 Veneto, 32100 Belluno, Italy
- 16Radiation Oncology Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
- 17Department of Radiation Oncology, University of Brescia and Civil Hospitals, Piazzale Spedali Civili 1, 25123 Brescia, Italy
- 18Radiation Oncology Unit, Santa Maria della Misericordia Hospital, 06132 Perugia, Italy
Abstract
Background/Objectives: Pancreatic adenocarcinoma remains one of the most lethal malignancies, with limited options for durable local control. Stereotactic body radiotherapy (SBRT) has emerged as a promising modality, particularly with the advent of MR-guided radiotherapy (MRgRT) and the possibility of delivering ablative dose levels. This multicenter study aimed to describe real-world Italian practice, evaluate safety and outcomes, and assess the association between ablative dosing, MRgRT, radiological response, and local control. Methods: A retrospective multicenter analysis was conducted across 17 Italian centers, including 473 patients treated with SBRT between 2021 and 2025. Clinical, dosimetric, toxicity, and outcome data were collected. BED10 was calculated for all treatments. Radiological response was assessed using RECIST 1.1 criteria, and toxicity was graded according to CTCAE v5.0. Survival outcomes were estimated using Kaplan–Meier analysis. Results: Median age was 69.6 years, and 59.4% of patients had ECOG performance status 0–1. The study population consisted predominantly of patients with non-metastatic disease, including resectable, borderline resectable, and unresectable locally advanced pancreatic cancer. Most patients received pre-SBRT chemotherapy (78%). The most common regimen was 45 Gy in 5 fractions. MRgRT was used in 20% of cases and was associated with reduced treatment margins (3–5 mm) and improved duodenal sparing (V33 < 0.5 cc in 91%). Acute grade ≥3 toxicity was 3.7%, and Late toxicity was uncommon, with grade ≥3 events observed in 3.0% of evaluable patients. Radiological response showed complete response in 5%, partial response in 27.7%, stable disease in 44.3%, and progressive disease in 23%, corresponding to an overall disease control rate of 77%. Patients receiving BED10 ≥ 80 Gy achieved higher partial response rates (38% vs. 19%) and lower progression rates (12% vs. 23%) compared with those receiving BED10 < 80 Gy. Median overall survival was 18.4 months, and median progression-free survival (PFS) was 10.2 months. Conclusions: SBRT demonstrated a favorable safety profile and was associated with encouraging clinical outcomes in real-world Italian practice. Ablative dose delivery (BED10 ≥ 80 Gy) was associated with improved radiological response and local control without an apparent increase in toxicity. MRgRT was associated with improved organ-at-risk protection and may facilitate the safe delivery of ablative dose levels. The present findings primarily reflect outcomes in a predominantly non-metastatic population and support the role of SBRT as a component of modern multidisciplinary pancreatic cancer management. This pooled national analysis may serve as the basis for future prospective studies aimed at optimizing patient selection, dose prescription, and image-guided treatment strategies.
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BibTeX
@article{niespolo2026pancreatic,
title = {{Pancreatic SBRT in Italian Clinical Practice: A Multicenter Analysis of 473 Patients Treated in 17 Centers}},
author = {Rita Marina Niespolo and Luca Nicosia and Eliana La Rocca and Angela Romano and Fernando Munoz and Alessia Surgo and Bruno Meduri and Pierfrancesco Franco and Sabrina Montrone and Andrea D’Aviero and Elena Galofaro and Francesca De Felice and Alessandra Arcelli and Giampaolo Montesi and Filippo De Renzi and Francesco Romeo Filippone and Marco Lorenzo Bonù and Marco Lupattelli},
journal = {Cancers},
year = {2026},
month = nov,
doi = {10.3390/cancers18213594},
url = {https://www.mdpi.com/2072-6694/18/21/3594},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Pancreatic SBRT in Italian Clinical Practice: A Multicenter Analysis of 473 Patients Treated in 17 Centers
AU - Rita Marina Niespolo
AU - Luca Nicosia
AU - Eliana La Rocca
AU - Angela Romano
AU - Fernando Munoz
AU - Alessia Surgo
AU - Bruno Meduri
AU - Pierfrancesco Franco
AU - Sabrina Montrone
AU - Andrea D’Aviero
AU - Elena Galofaro
AU - Francesca De Felice
AU - Alessandra Arcelli
AU - Giampaolo Montesi
AU - Filippo De Renzi
AU - Francesco Romeo Filippone
AU - Marco Lorenzo Bonù
AU - Marco Lupattelli
PY - 2026
DA - 2026/11/09
JO - Cancers
DO - 10.3390/cancers18213594
UR - https://www.mdpi.com/2072-6694/18/21/3594
AB - Background/Objectives: Pancreatic adenocarcinoma remains one of the most lethal malignancies, with limited options for durable local control. Stereotactic body radiotherapy (SBRT) has emerged as a promising modality, particularly with the advent of MR-guided radiotherapy (MRgRT) and the possibility of delivering ablative dose levels. This multicenter study aimed to describe real-world Italian practice, evaluate safety and outcomes, and assess the association between ablative dosing, MRgRT, radiological response, and local control. Methods: A retrospective multicenter analysis was conducted across 17 Italian centers, including 473 patients treated with SBRT between 2021 and 2025. Clinical, dosimetric, toxicity, and outcome data were collected. BED10 was calculated for all treatments. Radiological response was assessed using RECIST 1.1 criteria, and toxicity was graded according to CTCAE v5.0. Survival outcomes were estimated using Kaplan–Meier analysis. Results: Median age was 69.6 years, and 59.4% of patients had ECOG performance status 0–1. The study population consisted predominantly of patients with non-metastatic disease, including resectable, borderline resectable, and unresectable locally advanced pancreatic cancer. Most patients received pre-SBRT chemotherapy (78%). The most common regimen was 45 Gy in 5 fractions. MRgRT was used in 20% of cases and was associated with reduced treatment margins (3–5 mm) and improved duodenal sparing (V33 < 0.5 cc in 91%). Acute grade ≥3 toxicity was 3.7%, and Late toxicity was uncommon, with grade ≥3 events observed in 3.0% of evaluable patients. Radiological response showed complete response in 5%, partial response in 27.7%, stable disease in 44.3%, and progressive disease in 23%, corresponding to an overall disease control rate of 77%. Patients receiving BED10 ≥ 80 Gy achieved higher partial response rates (38% vs. 19%) and lower progression rates (12% vs. 23%) compared with those receiving BED10 < 80 Gy. Median overall survival was 18.4 months, and median progression-free survival (PFS) was 10.2 months. Conclusions: SBRT demonstrated a favorable safety profile and was associated with encouraging clinical outcomes in real-world Italian practice. Ablative dose delivery (BED10 ≥ 80 Gy) was associated with improved radiological response and local control without an apparent increase in toxicity. MRgRT was associated with improved organ-at-risk protection and may facilitate the safe delivery of ablative dose levels. The present findings primarily reflect outcomes in a predominantly non-metastatic population and support the role of SBRT as a component of modern multidisciplinary pancreatic cancer management. This pooled national analysis may serve as the basis for future prospective studies aimed at optimizing patient selection, dose prescription, and image-guided treatment strategies.
SN - 2072-6694
ER -