Todd Aguilera, Radiation Oncologist at UT Southwestern Medical Center, shared a post on X:
“As we get ready for AACR, Pancreatic Cancer and ASTRO25 … with PREOPANC2 hot off the press. Can ablative radiation before surgery help flip the script pancreatic cancer?
Let’s dive into our new data from UT Southwestern on neoadjuvant SABR + chemo.
Why care?
Up to 50 % of PDAC recurrences are local only (ESPAC4). Killing or removing every last cell around the tough surgical bed matters As systemic therapy improves local control may be the to improve survival.
Design: 181 pts resected (2012‑23) → all ≥3 mo chemo; 48 received 5‑fxn SAbR (up to 55 Gy). Borderline and locally advanced often had SAbR, so worse baseline anatomy, but still made it to the OR.
Pathology wins
- ypT0‑1 in 46 % with SAbR vs 28 % chemo‑only
- Fewer +nodes, less perineural invasion Translation: cleaner surgical bed & less microscopic spread at the time of surgery
Local control = where SAbR shines Matched cohort (25 vs 25): 2‑yr loco‑regional RFS 78 % vs 35 % → HR 0.24, p 0.009.
Arterial involvement? THE problem case.
With chemo only, 85 % recurred locally by 2 years. Add SAbR → flips to >70 % still controlled (HR 0.28).
Overall survival stayed similar (no harm signal, no diff in peri-op complications), with the main peri‑op issue being higher transfusions (borderline/LAPC are just tougher cases?).
Molecular scoop: RNA‑seq of resected PDAC shows SAbR lights up Type I IFN, IL‑12, CD8⁺ and NK signatures; T‑regs associate with failure. Immune priming? Conversely, high MYC‑target gene score flags pts who develop distant mets (HR ≈ 3).
Biomarker to watch?
Take‑homes SAbR + chemo → better pathologic response and local control Especially valuable in arterial‑abutment cases Could this prime checkpoint blockade? Trials needed?
Caveats: single‑center, retrospective, n=48 in SAbR arm. Complements RTOG-0848 showing survival benefit of RT for node negative resectable? What’s your take? I know Alliance discouraged many. But this series has 2.5x more patients with RT resected than in the Alliance trial.
Patient selection and MultiD care is critical. Grateful to Peter Leung, the AguileraLab team, the pancreatic cancer team, and especially our patients who trust our care!
What’s your current practice – do you incorporate SAbR? Perhaps we should consider?”
Title: Presurgical Ablative Radiation Is Associated with Local Control and Immune Response in Pancreatic Cancer
Journal: Clinical Cancer Research
Authors: Peter Q. Leung, Eslam A. Elghonaimy, Ahmed M. Elamir, Megan Wachsmann, Song Zhang, Neha Barrows, Hollis Notgrass, Ethan Johnson, Cheryl M. Lewis, Rachel von Ebers, Cassandra Hamilton, Samy Castillo-Flores, Ricardo E. Nunez-Rocha, Grace Josephson, Zhikai Chi, Salwan Al Mutar, Patricio M. Polanco, Nina N. Sanford, Syed M. Ali Kazmi, Matthew R. Porembka, David Hsiehchen, Adam C. Yopp, John C. Mansour, Muhammad S. Beg, Herbert J. Zeh, III, Todd A. Aguilera
More from Todd Aguilera on OncoDaily.