Synapse - Outcomes in locally advanced pancreatic cancer after induction ablative radiation therapy and resection

Outcomes in locally advanced pancreatic cancer after induction ablative radiation therapy and resection Journal Article

Authors:	Blair, A. B.; Jolissaint, J. S.; Foster, D.; Soares, K. C.; Balachandran, V. P.; Kingham, T. P.; Drebin, J. A.; D’Angelica, M. I.; Jarnagin, W. R.; Crane, C. H.; Reyngold, M.; Wei, A. C.
Article Title:	Outcomes in locally advanced pancreatic cancer after induction ablative radiation therapy and resection
Abstract:	Background: Ablative-dose radiotherapy (A-RT) may result in durable local control and encouraging survival for patients with locally advanced pancreatic cancer (LAPC). A subset of patients with LAPC are eligible for exploration after completion of induction chemotherapy and A-RT. Outcomes for this subset of patients are yet to be described. Methods: This was a single-institution retrospective analysis of patients who had LAPC treated with induction chemotherapy and A-RT (≥98 Gy biologically effective dose using 15 to 25 fractions in 3- to 4.5-Gy/fraction), then subsequently underwent surgical exploration. Results: During a 6-year period, 34 patients with LAPC underwent exploration after induction chemotherapy and A-RT. Chemotherapy was given before A-RT to all the patients, with the majority receiving FOLFIRINOX (94 %). The median time to exploration after completion of A-RT was 75 days. Pancreaticoduodenectomy was the most frequent procedure (n = 18), followed by distal pancreatectomy (n = 7), and resection was aborted in nine patients (26 %) after discovery of distant (n = 6) or locally unresectable (n = 3) disease. Vascular resection or divestment was required for 56 % of the patients. There were no postoperative pancreatic fistulae. However, clinically significant ascites were observed in 36 % of the resected patients. A major pathologic response was observed in 17 % of the resected specimens upon final pathologic review. Postoperative mortality within 90 days occurred for two patients (5.9 %). The median overall survival for the entire cohort was 31 months from the date of diagnosis and 24 months from completion of A-RT. Conclusions: Resection of LAPC is feasible for a select cohort of patients after A-RT, with encouraging 2-year overall survival. © Society of Surgical Oncology 2025.
Keywords:	adult; clinical article; treatment outcome; aged; aged, 80 and over; middle aged; antibiotic agent; antibiotic therapy; cancer surgery; survival rate; retrospective studies; overall survival; mortality; fluorouracil; advanced cancer; diarrhea; multimodality cancer therapy; gemcitabine; paclitaxel; cancer radiotherapy; pancreas cancer; radiation dose; combined modality therapy; pancreatic neoplasms; follow up; follow-up studies; antineoplastic agent; pancreaticoduodenectomy; antineoplastic combined chemotherapy protocols; cohort analysis; pathology; retrospective study; irinotecan; liver failure; folinic acid; pancreas tumor; reoperation; ablation techniques; pancreatectomy; surgery; postoperative infection; surgical drainage; surgical mortality; oxaliplatin; portal vein thrombosis; postoperative hemorrhage; endoscopy; leucovorin; hydration; therapy; ablation therapy; distal pancreatectomy; induction chemotherapy; chylous ascites; respiratory failure; anastomosis leakage; pancreas fistula; paracentesis; failure to thrive; very elderly; humans; prognosis; human; male; female; article; major pathological response; ablative dose radiotherapy
Journal Title:	Annals of Surgical Oncology
Volume:	32
Issue:	6
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2025-06-01
Start Page:	4108
End Page:	4116
Language:	English
DOI:	10.1245/s10434-025-17199-8
PUBMED:	40178674
PROVIDER:	scopus
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-105002147825&doi=10.1245%2fs10434-025-17199-8&partnerID=40&md5=3f371a69f578838c3f484a244821ea7a
Notes:	The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Alice C. Wei -- Source: Scopus