Pancreatic Cancer: SBRT Preserves Quality of Life, but Survival Signals Favour Conventional Chemoradiation: ASTRO Annual Meeting | October 2026

What Did the Study Find?

The SOFT Preop trial randomized 98 patients with resectable, borderline-resectable or selected locally advanced pancreatic ductal adenocarcinoma (PDAC) to preoperative stereotactic body radiotherapy (SBRT) or conventional chemoradiation, usually after induction chemotherapy.

• Treatment duration: SBRT required only 5 fractions, compared with 28 fractions of conventional chemoradiation.
• Primary endpoint—node positivity: Similar between SBRT and chemoradiation (41% vs 38%).
• Pathological response and surgical complications: No significant differences between groups.
• Local/regional recurrence: Numerically higher with SBRT (6 vs 2 patients).
• Median overall survival: 26 vs 43 months, numerically favoring chemoradiation, but not statistically significant.
• Three-year survival: 42.6% vs 57.5%, respectively.
• Median progression-free survival: 14.3 vs 21.6 months, also numerically favoring chemoradiation.
• Quality of life: SBRT significantly better preserved physical function and global physical health and reduced fatigue.

Why Does It Matter?

SBRT offers a major practical advantage: five treatment sessions instead of 28, reducing treatment burden and preserving quality of life without an observed increase in surgical complications.

However, the numerical differences in overall survival, progression-free survival and local recurrence raise questions about whether shorter treatment provides equivalent long-term cancer control.

GastroAGI Takeaway

SBRT offers convenience and better quality of life—but has not demonstrated oncological equivalence to conventional chemoradiation before pancreatic cancer surgery.

The trial provides reassuring evidence regarding surgical safety and pathological response, but the 17-month numerical overall-survival difference warrants further investigation.