This observational analysis aimed to evaluate the stereotactic body radiation therapy’s safety and feasibility with simultaneous integrated protection (SIP) and simultaneous integrated boost (SIB) in borderline resectable and locally advanced pancreatic ductal adenocarcinoma patients. The study involved patients that were receiving SBRT following induction chemotherapy from the year 2017-2018. The SBRT was administered in 5 consecutive fractions on a daily basis by delivering 30Gy to the planning target volume while simultaneously delivering a 50Gy SIB to the tumor–vessel interface. The SIP was created by lowering the previous dose to 25 Gy on the area overlapping between the planning target volume and the volume of the  planning organ affected by cancer.

The primary endpoint was acute and late gastrointestinal grade ≥3 toxicity. Secondary endpoints were freedom from local progression, overall survival, and progression-free survival. In total, fifty-nine consecutive patients  with 27 borderline resectable and 32 locally advanced patients were included. All patients except one, completed the SBRT treatment as planned, and 35 underwent surgical resection following the treatment procedure. No acute or late grade SBRT-related adverse events were observed. Resected patients had improved two year overall survival rates and median PFS relative to unresected patients. There was no difference in the survival rates between the two groups of patients observed in this study.