ArticleJournal of gastrointestinal oncology2026
Neoadjuvant radiotherapy after chemotherapy does not improve surgical or survival outcomes in borderline resectable pancreatic cancer.
Article in Journal of gastrointestinal oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The benefit of adding radiotherapy (RT) to modern chemotherapy in borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) remains uncertain. We evaluated the impact of neoadjuvant RT on surgical and survival outcomes in patients treated with contemporary systemic therapy. Methods: We conducted a retrospective cohort study of BR-PDAC patients who initiated neoadjuvant chemotherapy (2011-2023) at a high-volume cancer center. Regimens included FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) or gemcitabine/nab-paclitaxel. Selected patients received RT, most with fluoropyrimidine radiosensitization. Outcomes included resection rate, R0 margin, event-free survival (EFS), overall survival (OS), and recurrence. Multivariable Cox and logistic models adjusted for age, carbohydrate antigen 19-9 (CA19-9), Eastern Cooperative Oncology Group performance status (ECOG PS), vascular involvement, surgical resection, and RT. Results: Among 132 patients (median age 63 years), 91% received FOLFIRINOX; 68 (52% of nonprogressors) received RT. Resection was attempted in 80 patients and performed in 71 (54% overall); R0 was achieved in 57 (80% of resected). Median OS was 24.8 months for the cohort and 42.3 months among resected patients. First recurrence was predominantly distant (79%). In patients without progression or death during chemotherapy (n=101), RT was associated with lower resection rates (60.3% Conclusions: In this cohort of BR-PDAC treated with chemotherapy, the addition of RT was not associated with improved surgical or survival outcomes. These findings should be interpreted cautiously, given study limitations and support systemic therapy as the foundation of treatment.
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