Single-center study of nonoperative management of technically resectable pancreatic ductal adenocarcinoma with ablative radiation therapy

Surgical resection of pancreatic ductal adenocarcinoma (PDAC) modestly improves long-term survival. However, postoperative morbidity ofter interferes with administration of systemic therapy and may be unacceptable to some patients. Ablative radiation therapy (A-RT) has emerged as an effective noninvasive local treatment in many tumor types and may provide an alternative to surgery in select patients with resectable PDAC. In a cohort study of 25 consecutive patients with technically resectable PDAC, definitive A-RT (100-Gy biologically effective dose) was associated with favorable 2-year rates of local progression (20.8%) and overall survival (43.7%). The authors conclude that nonoperative management with A-RT may be an alternative option for localized pancreatic cancers, particularly when the risk of operative morbidity is high or functional consequences are severe.