# Conventionally Fractionated Radiotherapy (CFRT) Versus Stereotactic Body Radiotherapy (SBRT) for Locally Advanced Pancreatic Cancer: A Systematic Review and Meta-Analysis of Comparative Studies

## TL;DR

This study compares two radiotherapy methods for advanced pancreatic cancer and finds similar survival but less toxicity with stereotactic body radiotherapy.

## Contribution

A systematic review and meta-analysis comparing SBRT and CFRT in LAPC, focusing on survival and toxicity outcomes.

## Key findings

- No significant difference in overall or progression-free survival between SBRT and CFRT.
- SBRT was associated with lower severe acute toxicity compared to CFRT.
- Study evidence is limited by retrospective design and heterogeneity.

## Abstract

Locally advanced pancreatic cancer (LAPC) represents a major therapeutic challenge, as a large proportion of patients are not candidates for surgical resection. Radiotherapy plays an important role in disease management and may be delivered either through conventionally fractionated radiotherapy (CFRT) over several weeks or through stereotactic body radiotherapy (SBRT) using a small number of high-dose fractions. These approaches differ substantially in treatment schedule, radiation delivery, and toxicity patterns. Because SBRT is increasingly adopted in clinical practice, a clearer understanding of its clinical value compared with CFRT is needed. We therefore reviewed the available comparative studies to better clarify the relative role of CFRT and SBRT in the treatment of patients with LAPC.

Background: Stereotactic body radiotherapy (SBRT) has gained increasing interest in the treatment of locally advanced pancreatic cancer (LAPC), although its effectiveness has not been defined in randomized trials. This systematic review and meta-analysis aimed to compare clinical outcomes and treatment-related toxicity between SBRT and CFRT in LAPC. Methods: This analysis was performed in accordance with PRISMA guidelines (PROSPERO: CRD420251128943). MEDLINE and Scopus were searched for comparative studies published between January 2015 and July 2025. Five retrospective studies comprising 768 patients fulfilled the eligibility criteria. Pooled hazard ratios (HRs) were calculated for overall survival (OS) and progression-free survival (PFS), while risk ratios (RRs) were estimated for severe (grade ≥ 3) acute toxicity using random-effects models. Study quality was evaluated using the ROBINS-I tool. Results: No significant OS or PFS differences were observed between SBRT and CFRT. SBRT was associated with a lower incidence of severe acute toxicity. The overall risk of bias across studies was moderate. Conclusions: SBRT appears to achieve survival outcomes comparable to CFRT with a favorable acute toxicity profile in patients with LAPC. Nevertheless, the current evidence is limited by retrospective designs and heterogeneity, highlighting the need for prospective randomized trials to define the role of SBRT in this setting.