Top Line: What are the outcomes following ablative radiation for resectable pancreatic ductal adenocarcinoma?
The Study: Radiation has played less of a role in the management of PDAC over the past several years. With a few exceptions, multiple trials in different clinical scenarios have found limited survival benefit. Some argue that the perceived lack of benefit from radiation stems from the historic use of modest radiation dose. This single center cohort study describes outcomes for 25 consecutive patients with resectable PDAC who were treated with ablative radiation. Included patients had radiographically resectable, T1-2 (60% T2) N0-1 (84% N0) disease, but they were considered too high risk for surgery. The median age was 80 years and most patients (80%) had a KPS of 80 or lower. Most (68%) received neoadjuvant chemotherapy, but 32% didn’t receive any chemotherapy at all. The most common dose-fractionation regimen was 75 Gy in 25 fractions (52%) followed by 67.5 Gy in 15 fractions (36%), 50 Gy in 5 fractions (8%), and 60 Gy in 10 fractions (4%). The median GTV coverage by the prescription dose was 79.7% (46.7% to 100%). Local control was 85.6% at 1 year and 79.2% at 2 years. Overall survival at 2 years was 43.7%. The rate of grade 3+ treatment related toxicity was 12% and included upper GI bleeding and gastric outlet obstruction.
TBL: Despite most patients having advanced age and poor performance status, radiation using ablative doses resulted impressive local control in this cohort of patients with radiographically resectable PDAC. | Reyngold, JAMA Oncol 2025
The Study: Radiation has played less of a role in the management of PDAC over the past several years. With a few exceptions, multiple trials in different clinical scenarios have found limited survival benefit. Some argue that the perceived lack of benefit from radiation stems from the historic use of modest radiation dose. This single center cohort study describes outcomes for 25 consecutive patients with resectable PDAC who were treated with ablative radiation. Included patients had radiographically resectable, T1-2 (60% T2) N0-1 (84% N0) disease, but they were considered too high risk for surgery. The median age was 80 years and most patients (80%) had a KPS of 80 or lower. Most (68%) received neoadjuvant chemotherapy, but 32% didn’t receive any chemotherapy at all. The most common dose-fractionation regimen was 75 Gy in 25 fractions (52%) followed by 67.5 Gy in 15 fractions (36%), 50 Gy in 5 fractions (8%), and 60 Gy in 10 fractions (4%). The median GTV coverage by the prescription dose was 79.7% (46.7% to 100%). Local control was 85.6% at 1 year and 79.2% at 2 years. Overall survival at 2 years was 43.7%. The rate of grade 3+ treatment related toxicity was 12% and included upper GI bleeding and gastric outlet obstruction.
TBL: Despite most patients having advanced age and poor performance status, radiation using ablative doses resulted impressive local control in this cohort of patients with radiographically resectable PDAC. | Reyngold, JAMA Oncol 2025