ESTRO 2025 - Abstract Book

S1784

Clinical – Upper GI

ESTRO 2025

Results: 25 patients were enrolled between 25 August 2022 and 04 October 2023 and 20 patients underwent SMART. Of these 20 patients, the mean age was 71 years (range 58-85 years), 60% were females, and all patients were ECOG 0 1.The commonest location was head of pancreas (n = 12) and most patients (n= 19) received induction chemotherapy. On-table adaptive re-planning was performed for all delivered fractions. There were no DLT or treatment related deaths. Grade G3 and above toxicities were fatigue (n=3), biliary obstruction (n=2) and duodenal obstruction (n=1). Toxicity attributed to SMART at each level is listed in Table 1.

The median follow-up time of 9.8 months (range 3.5 - 20.3 months) from SMART. The 12-month OS and LPFS rate (%) from SMART were 62.9 (42.7-92.5) and 62.3 (43.4-89.5) respectively and 18-month OS and LPFS rate (%) from SMART were 50.3(28.8-90.2) and 49.8(28.2-88.0) respectively. Detailed survival outcomes in different subgroups are listed in Table 2.

Conclusion: EMERALD demonstrates that ultra hypo-fractionated SMART for localised pancreatic cancer can be delivered in single and three fractions with acceptable toxicity and clinical outcomes . These regimens merit further investigation in phase II/III trials to evaluate clinical benefit and cost effectiveness

Keywords: Pancreas, ultra-hypofractioned MRgSABR, Trial