Among patients with borderline resectable and locally advanced pancreatic adenocarcinoma (BRPC/LAPC) treated with induction multi-agent chemotherapy (CTX) followed by stereotactic body radiation therapy (SBRT), margin-negative (R0) resection was successfully achieved in a high proportion of patients but locoregional failure remained common, emphasizing the necessity to continue to optimize radiation delivery in this context.

• In BRPC/LAPC patients (n= 155) treated at a high-volume institution with induction CTX followed by 5-fraction SBRT, the surgical, pathologic, and survival outcomes were analyzed.

• Of 64 BRPC patients, 50 (78%) had resection; among those, R0 resection was achieved in 48 (96%) patients.

• Of 91 LAPC patients, 57 (63%) had resection; R0 resection was achieved in 50 (88%) cases.

• Despite the high R0 rate, 33% had locoregional failure, which was a component of 44% of all failures.

• Post-SBRT, median overall survival (OS) and progression-free survival (PFS) were noted to be 18.7 and 7.7 months, respectively.

• Post-SBRT, 1- and 2-year OS probabilities were estimated to be 70% and 45%, whereas, from diagnosis, they were 93% and 51%.