Quality of life and toxicity in patients with pancreatic ductal adenocarcinoma treated with online adaptive stereotactic MR-guided radiotherapy.

Introduction: Online adaptive magnetic resonance guided radiotherapy (MRgRT) using a hybrid MRI and linear accelerator (MR-Linac) enables stereotactic ablative radiation doses to pancreatic tumors. We evaluated patient-reported quality of life (QoL) and clinician-reported toxicity in patients with pancreatic ductal adenocarcinoma (PDAC) following stereotactic MRgRT.

Method: Patients with non-metastatic PDAC treated with stereotactic MRgRT on a 1.5T MR-Linac according to local standard practices between May 2019 and December 2023 were identified using the international, prospective observational XXX study. Patient-reported QoL and clinician-reported toxicity were assessed using the EORTC QLQ-C30 and Common Terminology Criteria for Adverse Events (CTCAE) at baseline, 3, 6, and 12 months of follow-up. Patients with new systemic therapy or resection were censored. Patients with disease progression were additionally censored for a sensitivity analysis. Mean difference (MD) QoL scores from baseline were estimated using a linear mixed model, which were evaluated for clinical relevance (MD≥10) and statistical significance (p≤0.05). Acute (≤3 months follow-up) and late (3 to 12 months follow-up) toxicity was captured if grade ≥3.

Results: Included were 127 patients from eight centers. Treatment dose ranged from 30-50 Gy in five fractions. Functional QoL domains remained stable over time. Statistically significant and clinically relevant improvement was found for nausea and vomiting (MD -10, 95%CI -17 to -3; p<0.001), and in the sensitivity analysis for nausea and vomiting (MD -11, 95%CI -18 to -3; p<0.001) and appetite (MD -14, 95%CI -28 to 0; p=0.05), all at six months follow-up. No clinically relevant and statistically significant deterioration was found in other domains. Acute and late grade 3 toxicity occurred in 2 patients and 1 patient, respectively.

Conclusion: Stereotactic MRgRT for patients with non-metastatic PDAC was associated with stable functioning, improved disease-related symptoms, and minimal toxicity up to 12 months following treatment.