Quality of Life and Toxicity in Patients With Pancreatic Ductal Adenocarcinoma Treated With Online Adaptive Stereotactic Magnetic Resonance Guided Radiation Therapy

Abstract

Purpose: Online adaptive magnetic resonance guided radiation therapy (MRgRT) using a hybrid magnetic resonance imaging and linear accelerator 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 after stereotactic MRgRT.

Method: Patients with nonmetastatic pancreatic ductal adenocarcinoma treated with stereotactic MRgRT on a 1.5-Tesla magnetic resonance imaging and linear accelerator according to local standard practices between May 2019 and December 2023 were identified using the international, prospective observational Multi-OutcoMe EvaluatioN of radiation Therapy Using the MR-Linac study (MOMENTUM, NCT04075305). Patient-reported QoL and clinician-reported toxicity were assessed using the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaires and National Cancer Institute Common Terminology Criteria for Adverse Events 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 ≤ .05). Acute (≤3 months follow-up) and late (3-12 months follow-up) toxicity was captured if grade ≥3.

Results: A total of 127 patients were included from 8 centers. Treatment dose ranged from 30 to 50 Gy in 5 fractions. Functional QoL domains remained stable over time. A statistically significant and clinically relevant improvement was found for nausea and vomiting (MD -10; 95% CI, -17 to -3; P < .001), and in the sensitivity analysis for nausea and vomiting (MD -11; 95% CI -18 to -3; P < .001) and appetite (MD -14; 95% CI -28 to 0; P = .05), all at 6 months follow-up. No clinically relevant and statistically significant deterioration was found in other domains. New-onset acute and late grade 3 toxicity occurred in 2 patients and 1 patient, respectively.

Conclusion: Stereotactic MRgRT for patients with nonmetastatic pancreatic ductal adenocarcinoma was associated with stable functioning, improved disease-related symptoms, and minimal toxicity up to 12 months after treatment.