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Robotic Pancreatoduodenectomy for Pancreatic Head Cancer: a Case Report of a Standardized Technique

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Published on: June 24, 2022

First Spanish Experience with Stereotactic MR-Guided Adaptive Radiotherapy (SMART) in Borderline Resectable and

Daniela Gonsalves^1,2,3, Abrahams Ocanto^1,2, Eduardo Meilan⁴

¹Department Radiation Oncology, GenesisCare Madrid, Hospital Vithas la Milagrosa, 28010 Madrid, Spain.

|October 29, 2025

Summary

Stereotactic MR-guided adaptive radiotherapy (SMART) shows feasibility and safety for pancreatic cancer in Spain. This innovative radiation technique offers promising local control and survival outcomes with minimal toxicity.

Keywords:

MR-guided radiotherapy pancreatic cancer stereotactic body radiotherapy (SBRT)

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Robot Assisted Distal Pancreatectomy with Celiac Axis Resection DP-CAR for Pancreatic Cancer: Surgical Planning and Technique

Published on: August 14, 2021

Area of Science:

Oncology
Radiation Oncology
Medical Physics

Background:

Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis in Spain, with limited surgical options at diagnosis.
Effective non-surgical treatments are crucial for patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC).
Stereotactic MR-guided adaptive radiotherapy (SMART) offers potential for safe, high-dose radiation delivery with low toxicity.

Purpose of the Study:

To report the first national experience in Spain using SMART for BRPC and LAPC.
To evaluate the feasibility, safety, and early clinical outcomes of SMART in this patient population.
To assess progression-free survival (PFS) and overall survival (OS) rates following SMART treatment.

Main Methods:

A prospective observational study included 28 patients with histologically confirmed BRPC or LAPC.
Patients received induction chemotherapy (mainly FOLFIRINOX) followed by SMART in five fractions (40-50 Gy) using a 0.35T MR-guided linear accelerator.
Daily online adaptive recontouring and replanning were performed, with toxicity assessed via CTCAE v5.0 and survival analyzed using Kaplan-Meier methods.

Main Results:

At a median follow-up of 7.4 months post-SMART, 6-month local progression-free survival (LPFS) was 89.3% from SMART start and 82.1% from diagnosis.
Six-month distant progression-free survival (DPFS) was 92.9%, with median PFS of 11.5 months.
No grade ≥3 adverse events were observed; toxicity was limited to grade 2 abdominal pain in 14.3% of patients.

Conclusions:

SMART is a feasible and safe treatment option for BRPC and LAPC in clinical practice.
Early outcomes demonstrate encouraging local control and survival rates with a favorable toxicity profile.
These findings support further investigation and broader implementation of SMART for pancreatic cancer.