Objectives: To assess the feasibility of SBRT in the setting of locally advanced and borderline resectable pancreatic cancers using fiducial marker guidance and concurrent chemotherapy.

Methods: In this study we reviewed the outcomes of 21 patients who received SBRT with concurrent chemotherapy. In the first phase, patients received concurrent capecitabine with SBRT to a dose of 25Gy in five fractions. In the second phase, treatment was escalated to neoadjuvant FOLFIRINOX followed by concurrent treatment consisting of 30Gy in five fractions with a simultaneous integrated boost to 35Gy to the area of vessel abutment, with capecitabine.

Results: Our results indicate that the toxicity associated with this treatment is minimal. After completion of neoadjuvant chemotherapy, approximately 40% of cases experienced high grade toxicity which was predominantly related to bone marrow suppression. After completion of concurrent chemotherapy and SBRT, no patients reported high grade toxicity. Local control rates were 75% with median survival of 10 months.

Conclusions: We conclude that with fiducial marker guidance, SBRT is technically feasible. Concurrent treatment appears to be well tolerated with the most significant toxicities reported after neoadjuvant chemotherapy.