Systematic review: Stereotactic Body Radiation Therapy for Pancreatic Cancer: Evaluating its Efficacy, Safety, and Future Prospects

AIM: This systematic narrative review evaluates the efficacy, safety, and future potential of Stereotactic Body Radiation Therapy (SBRT) in locally advanced pancreatic cancer (LAPC), particularly for patients unsuitable for surgery. METHODS: A systematic search of PubMed, Embase, and the Cochrane Library identified English and select non-English studies published between January 2010 and November 2025. Search terms included "pancreatic cancer," "SBRT," "locally advanced pancreatic cancer," "adaptive radiotherapy," "proton therapy," "toxicity," and "outcomes." Eligible peer-reviewed studies (clinical trials, cohort studies, systematic reviews; ≥20 patients) reporting local control (LC), overall survival (OS), progression-free survival (PFS), and toxicity were included. Study quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. Owing to heterogeneity, narrative synthesis was performed, supplemented by pooled estimates from recent meta-analyses following PRISMA guidelines. RESULTS: Thirty-five studies were included (25 photon SBRT, 6 proton, 4 carbon-ion). One-year LC ranged 70-95% (pooled 82%); median OS 13-20 months (pooled 16.8 months). Higher BED₁₀ (>70 Gy) improved LC (HR 0.68). Grade ≥3 acute toxicity was 3%, and late gastrointestinal toxicity 2%. Adaptive MRI-guided SBRT reduced margins (2-3 mm) and toxicity (∼40%) while maintaining >90% LC. Proton therapy achieved mOS 19.5months; carbon-ion therapy reported 95% 1-year LC. Distant progression (60%) predominated. CONCLUSION: SBRT provides high local control with acceptable toxicity in LAPC. Advanced adaptive and particle techniques enhance precision, but systemic progression remains the main challenge, underscoring the need for multimodal strategies and large randomized trials. ADVANCES IN KNOWLEDGE: This article summarizes the efficacy of SBRT in LAPC.