{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T02:55:52Z","timestamp":1777949752193,"version":"3.51.4"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Solid pseudopapillary tumors (SPTs) of the pancreas are rare, low-grade malignancies that generally have favorable outcomes when diagnosed at an early stage and can be resected. However, treatment options for patients with unresectable or metastatic disease are limited, and the role of radiotherapy (RT) is not well defined, especially for lesions near dose-limiting organs at risk (OARs). Advances in magnetic resonance\u2013guided radiotherapy (MRgRT) can facilitate safe dose escalation for anatomically unfavorable tumors that may improve clinical outcomes. We report the use of dose-escalated MRgRT for &amp;gt;10\u00a0cm pancreatic SPT with liver oligometastases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 63-year-old female was incidentally found to have a 7-cm mass in the pancreatic body and three hepatic lesions with biopsy confirmation of SPT. Surgery was attempted after 3 months of chemotherapy but aborted intraoperatively due to extensive vascular involvement. She received four cycles of FOLFOX followed by definitive RT to the primary tumor that had enlarged to 10\u00a0cm. Given the tumor\u2019s size and extensive abutment of the stomach and bowel, she was treated on a 0.35-Tesla MR-Linac using a dose-painted, simultaneous integrated boost with 50.4 Gy in 28 fractions prescribed to the primary tumor and 75.6 Gy in 28 fractions prescribed to a central tumor volume. Concurrent chemotherapy was not used. One month later, two of the three liver metastases were treated with MRgRT to 40 Gy in five fractions. One sub-centimeter liver metastasis was observed due to concerns about cumulative liver dose, although due to eventual slight progression, it was treated 19 months later with the MR-Linac to 35 Gy in one fraction. All RT courses were well tolerated with no grade \u22652 toxicity. She is alive, asymptomatic, and without evidence of progression nearly 36 months after initiating RT and achieved a favorable radiographic response in all treated lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case report demonstrates that dose-escalated MRgRT can treat anatomically unfavorable pancreatic SPT and achieve favorable long-term efficacy without significant toxicity. These data add to the growing body of evidence that MRgRT may significantly improve the therapeutic ratio over computed tomography (CT)\u2013guided RT for complex abdominal tumors by facilitating tumor dose escalation while meeting OAR constraints.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1808600","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T04:24:57Z","timestamp":1777868697000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ablative stereotactic MR-guided radiotherapy for &gt;10\u00a0cm solid pseudopapillary tumor of the pancreas with liver oligometastases: a case report and literature review"],"prefix":"10.3389","volume":"16","author":[{"given":"Robert A.","family":"Herrera","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Miami Cancer Institute","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolai","family":"Strusberg-Fernandez","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Miami Cancer Institute","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eyub Y.","family":"Akdemir","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Miami Cancer Institute","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"De Zarraga","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Miami Cancer Institute","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Horacio","family":"Asbun","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Miami Cancer Institute","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"McCulloch","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Miami Cancer Institute","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nema","family":"Bassiri","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Miami Cancer Institute","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael D.","family":"Chuong","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Miami Cancer Institute","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2005.02.011","article-title":"Solid pseudopapillary tumors of the pancreas: Review of 718 patients reported in English literature","volume":"200","author":"Papavramidis","year":"2005","journal-title":"J Am Coll Surgeons"},{"key":"B2","article-title":"Tumors of the pancreas","author":"Frantz","year":"1959"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1097\/mpa.0000000000000061","article-title":"A systematic review of solid-pseudopapillary neoplasms: Are these rare lesions","volume":"43","author":"Law","year":"2014","journal-title":"Pancreas"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1097\/pas.0000000000000141","article-title":"Solid pseudopapillary neoplasm of the pancreas: Clinicopathologic and survival analyses of 64 cases from a single institution","volume":"38","author":"Estrella","year":"2014","journal-title":"Am J Surg Pathol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2019-0473-ra","article-title":"Pancreatic solid pseudopapillary neoplasm: Key pathologic and genetic features","volume":"144","author":"La Rosa","year":"2020","journal-title":"Arch Pathol Lab Med"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1097\/01.pas.0000155159.28530.88","article-title":"Clinically aggressive solid pseudopapillary tumors of the pancreas: A report of two cases with components of undifferentiated carcinoma and a comparative clinicopathologic analysis of 34 conventional cases","volume":"29","author":"Tang","year":"2005","journal-title":"Am J Surg Pathol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.4253\/wjge.v10.i9.145","article-title":"Clinical update on the management of pseudopapillary tumor of pancreas","volume":"10","author":"Lanke","year":"2018","journal-title":"World J Gastrointest Endosc"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v16.i10.1209","article-title":"Solid pseudopapillary tumor of the pancreas: A review of 553 cases in Chinese literature","volume":"16","author":"Yu","year":"2010","journal-title":"World J Gastroenterol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1349282","article-title":"Long-term survival, quality of life, and molecular features of the patients with solid pseudopapillary neoplasm of the pancreas: A retrospective study of 454 cases","volume":"278","author":"Liu","year":"2023","journal-title":"Ann Surg"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.21037\/aos.2017.11.01","article-title":"Solid pseudopapillary neoplasm of the pancreas: National Cancer Data Base analysis of a gender-specific carcinoma with good prognosis","volume":"1","author":"Wang","year":"2017","journal-title":"Art Surg"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(05)01770-5","article-title":"Preoperative gemcitabine for unresectable, solid pseudopapillary tumour of the pancreas","volume":"6","author":"Maffuz","year":"2005","journal-title":"Lancet Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2009.07.026","article-title":"Downsizing to resectabilty of a large solid and cystic papillary tumor of the pancreas by single-agent chemotherapy","volume":"44","author":"Kanter","year":"2009","journal-title":"J Pediatr Surg"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2010.02.045","article-title":"Management of unresectable solid papillary cystic tumor of the pancreas. A case report and literature review","volume":"45","author":"Soloni","year":"2010","journal-title":"J Pediatr Surg"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2020-237309","article-title":"Solid pseudopapillary neoplasm of pancreas with distant metastasis during pregnancy: A diagnostic and treatment challenge","volume":"13","author":"Santos","year":"2020","journal-title":"BMJ Case Rep CP"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1200\/po.18.00182","article-title":"Response to mammalian target of rapamycin\u2013based therapy and incidental finding of Lynch syndrome in a patient with solid pseudopapillary neoplasm of the pancreas with AKT1_E17K mutation","volume":"2","author":"Cuglievan","year":"2018","journal-title":"JCO Precis Oncol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1200\/po.18.00304","article-title":"Everolimus is effective against metastatic solid pseudopapillary neoplasm of the pancreas: A case report and literature review","volume":"3","author":"Jorgensen","year":"2019","journal-title":"JCO Precis Oncol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.729151","article-title":"Case report: Targeted therapy for metastatic solid pseudopapillary neoplasm of the pancreas with CTNNB1 and PTEN mutations","volume":"11","author":"Wang","year":"2021","journal-title":"Front Oncol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1097\/01.coc.0000190457.43060.fd","article-title":"Intensity-modulated radiation therapy for unresectable solid pseudopapillary tumor of the pancreas","volume":"29","author":"Zauls","year":"2006","journal-title":"Am J Clin Oncol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1386987","article-title":"Case report: Clinical analysis and literature review of five cases of metastatic solid pseudopapillary tumor of the pancreas","volume":"14","author":"Hu","year":"2024","journal-title":"Front Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.888462","article-title":"Induction chemotherapy and ablative stereotactic magnetic resonance image-guided adaptive radiation therapy for inoperable pancreas cancer","volume":"12","author":"Chuong","year":"2022","journal-title":"Front Oncol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2025.02.022","article-title":"Moving from the background towards the spotlight: A critical review of radiation therapy for locally advanced pancreas cancer","volume":"122","author":"Chuong","year":"2025","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2023.110064","article-title":"Stereotactic MR-guided on-table adaptive radiation therapy (SMART) for borderline resectable and locally advanced pancreatic cancer: A multi-center, open-label phase 2 study","volume":"191","author":"Chuong","year":"2024","journal-title":"Radiotherapy Oncol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s12328-020-01262-w","article-title":"A case of recurrence of a solid pseudopapillary neoplasm of the pancreas effectively treated with proton beam radiotherapy","volume":"14","author":"Kodama","year":"2021","journal-title":"Clin J Gastroenterol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1097\/mpa.0000000000001112","article-title":"Survival and prognostic factors in patients with solid pseudopapillary neoplasms of the pancreas","volume":"47","author":"Huffman","year":"2018","journal-title":"Pancreas"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19851215)56:12<2783::aid-cncr2820561211>3.0.co;2-q","article-title":"A role for radiotherapy in the treatment of solid and papillary neoplasms of the pancreas","volume":"56","author":"Fried","year":"1985","journal-title":"Cancer"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19900701)66:1<193::aid-cncr2820660134>3.0.co;2-6","article-title":"Malignant papillary cystic tumor of the pancreas","volume":"66","author":"Cappellari","year":"1990","journal-title":"Cancer"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.12659\/AOT.908764","article-title":"Liver transplantation for a metastatic pancreatic solid-pseudopapillary tumor (Frantz tumor): A case report","volume":"23","author":"W\u00f3jciak","year":"2018","journal-title":"Ann Transplant"},{"key":"B28","doi-asserted-by":"publisher","first-page":"98","DOI":"10.4103\/jncd.jncd_4_19","article-title":"Expanding role of radiation in pancreatic tumors\u2013A rare case report and a new horizon","volume":"4","author":"Kapoor","year":"2019","journal-title":"Int J Noncommunicable Dis"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.18103\/mra.v12i8.5515","article-title":"Recurrent solid pseudopapillary tumor of the pancreas with direct extension into gastric mucosa: A case report with consideration for patient management","volume":"12","author":"Rajahraman","year":"2024","journal-title":"Med Res Arch"},{"key":"B30","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1186\/s13014-019-1308-y","article-title":"MR-guidance in clinical reality: Current treatment challenges and future perspectives","volume":"14","author":"Corradini","year":"2019","journal-title":"Radiat Oncol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.3390\/cancers17020208","article-title":"Evolving trends and patterns of utilization of magnetic resonance-guided radiotherapy at a single institution, 2018\u20132024","volume":"17","author":"Herrera","year":"2025","journal-title":"Cancers"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2024.07.2190","article-title":"Phase 2 trial of stereotactic MR-guided adaptive radiation therapy in one fraction (SMART ONE)","volume":"120","author":"Chuong","year":"2024","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2025.12.018","article-title":"Multi-institutional analysis of MR-guided single-fraction stereotactic ablative body radiation therapy: Feasibility, safety, and efficacy","author":"Fuchs","year":"2025","journal-title":"Int J Radiat Oncol Biol Phys"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1808600\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T04:24:59Z","timestamp":1777868699000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1808600\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,4]]},"references-count":33,"alternative-id":["10.3389\/fonc.2026.1808600"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1808600","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,4]]},"article-number":"1808600"}}