Adaptive Radiotherapy Improves Outcomes in Locally Advanced Pancreatic Cancer: JAMA
Researchers have found in a new study that among patients with locally advanced pancreatic cancer (LAPC) and extensive vascular encasement after induction chemotherapy, hypofractionated adaptive radiotherapy (A-RT) was associated with encouraging overall survival, regardless of whether surgical resection was ultimately performed. A-RT did not compromise resectability or increase postoperative complications, while also serving as an effective definitive treatment for unresectable disease, supporting its potential role in improving outcomes in this challenging patient population.
The study was published in JAMA Surgery by Marsha R. and colleagues. The safety, resectability rates, and overall survival outcomes from ablative radiotherapy were studied in 48 patients recruited between June 2018 and April 2024. Patients included in the study were those who had confirmed cases of pancreatic adenocarcinoma that were deemed as unresectable by multidisciplinary consultation, after being treated with at least 3 months of induction therapy, mainly with mFOLFIRINOX (94%) or gemcitabine plus nab-paclitaxel.
Participants underwent hypofractionated A-RT in a dose of 67.5 Gy in 15 fractions or 75 Gy in 25 fractions together with capecitabine, and then surgical assessment. Coprimary end points included resectability rate and 2-year overall survival, whereas secondary end points included 90-day surgical adverse events and 2-year locoregional and distant metastases.
Key findings:
- A group of 48 people participated in the A-RT trial. Among those participants, 25 were men.
- The average age was 67 years with the average tumor size being 4.1 cm.
- Almost all patients, 47 people, experienced both arterial and venous problems with their function.
- The average carbohydrate antigen 19-9 of all the participants equaled 88 U/mL. The majority of participants, 45 people, took mFOLFIRINOX.
- Furthermore, 17 patients underwent laparoscopy of which 13 underwent a resection during surgery.
- The majority of surgical resections were pancreaticoduodenectomy, while there were only 2 surgeries of pancreatic resection.
- The follow-up period was 3 years, and during that time 2-year survival was 38%.
- The incidence of local progression was 11% in the first group and 15% in the second one.
- The percentage of distant metastases during 2 years was 73%.
- There were no deaths that occurred within 90 days after surgery.
In summary, for LAPC patients with extensive vascular invasion after induction chemotherapies, hypofractionated A-RT before possible surgery proved to be beneficial regarding OS in both patients who underwent surgery and those who did not undergo surgery. Hypofractionated A-RT in multidisciplinary treatment strategies provides an opportunity to extend patient survival and ensure local tumor control.
Reference:
Reyngold M, Wei AC, O’Reilly EM, et al. Maximal Ablative Irradiation Because of Encasement for Patients With Locally Advanced Pancreatic Cancer: A Nonrandomized Clinical Trial. JAMA Surg. Published online July 29, 2026. doi:10.1001/jamasurg.2026.2988
