Ablative Radiation Therapy Demonstrates Promise Among Patients With Resectable Pancreatic Ductal Adenocarcinoma

According to results from a cohort study, ablative radiation therapy demonstrated clinical promise among patients with technically resectable pancreatic ductal adenocarcinoma. 

For patients who have undergone surgical resection for pancreatic ductal adenocarcinoma,  “postoperative morbidity often interferes with administration of systemic therapy and may be unacceptable to some patients,” stated Marsha Reyngold, MD, PhD, Memorial Sloan Kettering Cancer Center, New York, New York, and coauthors. They went on, “Ablative radiation therapy has emerged as an effective noninvasive local treatment in many tumor types and may provide an alternative to surgery in select patients.”

In this study, researchers enrolled 25 patients with radiographically resectable T1 to T2 pancreatic ductal adenocarcinoma with no regional lymph node or distant metastases who were not eligible to undergo surgical resection due to noncancer-related comorbidities. Patients received either 75 Gy in 25 fractions (n = 13), 67.5 Gy in 15 fractions (n = 9), 60 Gy in 10 fractions (n = 1) using conventional linear accelerators, or 50 Gy in 5 fractions (n = 2) using magnetic resonance imaging-guided linear accelerator. The primary end point was overall survival (OS). Key secondary end points included cumulative incidence of local progression, distant metastasis-free survival, and safety. 

At analysis, 80% of patients had a Karnofsky Performance Status score of ≤ 80. The 2-year OS rate was 43.7%. The cumulative incidence of local progression was 20.8% and the distant metastasis-free survival rate was 20%. The most common grade 3 adverse events included acute (n = 3) and late (n = 1) gastrointestinal tract toxic effects. No ≥ grade 4 adverse events were observed. 

“In this cohort study, [ablative radiation therapy] in patients with technically resectable [pancreatic ductal adenocarcinoma] led to effective local tumor control and favorable OS despite advanced age, poor Karnofsky Performance Status score, and conservative use of chemotherapy in the cohort studied,” concluded Dr Reyngold et al. “These data support a prospective study of [ablative radiation therapy] for the management of resectable [pancreatic ductal adenocarcinoma].” 

Source: 

Reyngold M, Schoenfeld JD, O’Reilly EM, et al. Nonoperative management of technically resectable pancreatic cancer with ablative radiation therapy. JAMA Oncol. Published Online: April 10, 2025. doi: 10.1001/jamaoncol.2025.0460