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. 2025 Apr;32(4):2819-2829.
doi: 10.1245/s10434-024-16743-2. Epub 2025 Jan 14.

Efficacy of Neoadjuvant Radiotherapy After Chemotherapy and the Optimal Interval from Radiotherapy to Surgery for Borderline Resectable and Resectable Pancreatic Cancer

Won-Gun Yun  1   2 , Yoon Soo Chae  1   2 , Youngmin Han  1   2 , Hye-Sol Jung  1   2 , Young Jae Cho  1   2 , Hyun-Cheol Kang  3   4 , Wooil Kwon  1   2 , Joon Seong Park  1   2 , Eui Kyu Chie  5   6 , Jin-Young Jang  7   8
Affiliations

Efficacy of Neoadjuvant Radiotherapy After Chemotherapy and the Optimal Interval from Radiotherapy to Surgery for Borderline Resectable and Resectable Pancreatic Cancer

Won-Gun Yun et al. Ann Surg Oncol. 2025 Apr.

Abstract

Background: Benefits of neoadjuvant treatment for pancreatic cancer with major vessel invasion has been demonstrated through randomized controlled trials; however, the optimal neoadjuvant treatment strategy remains controversial, especially for radiotherapy. Therefore, we aimed to evaluate the efficacy and safety of neoadjuvant radiotherapy followed by chemotherapy and the optimal time interval to undergo surgery after radiotherapy in (borderline) resectable pancreatic cancer.

Methods: Between 2013 and 2022, patients with (borderline) resectable pancreatic cancer with vessel contact who received 5-fluorouracil with leucovorin, oxaliplatin, and irinotecan or gemcitabine and nanoparticle albumin-bound paclitaxel as initial treatment following surgery were included. Patients who received radiotherapy after chemotherapy and those who did not were matched using 1:1 nearest-neighbor propensity scores. Propensity scores were measured using the tumor size at initial image, duration of neoadjuvant chemotherapy, and responsiveness to neoadjuvant chemotherapy.

Results: Of 212 patients, 166 patients were retrieved for the matched cohort. Patients who received radiotherapy had significantly better postoperative survival, local control, and R0 resection rates than those who did not. Furthermore, patients who underwent surgery within 4 weeks after completing radiotherapy had lower intraoperative blood loss and a clinically relevant postoperative pancreatic fistula rate than those who underwent surgery after more than 4 weeks.

Conclusions: In patients with (borderline) resectable pancreatic cancer with vessel contact who were scheduled for curative-intent surgery after neoadjuvant chemotherapy, additional radiotherapy was associated with better postoperative survival and local control. Furthermore, our findings suggested that scheduling surgery within 4 weeks following radiation therapy might enhance the perioperative outcomes.

Keywords: Neoadjuvant chemotherapy; Neoadjuvant radiotherapy; Pancreatectomy; Pancreatic cancer; Stereotactic body radiation therapy.

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Conflict of interest statement

Disclosure: Won-Gun Yun, Yoon Soo Chae, Youngmin Han, Hye-Sol Jung, Young Jae Cho, Hyun-Cheol Kang, Wooil Kwon, Joon Seong Park, Eui Kyu Chie, and Jin-Young Jang declare no competing interests that may be relevant to the contents of this study.

Figures

Fig. 1
Fig. 1
a POS, b LFFI, and c DMFI for patients who did or did not receive neoadjuvant radiotherapy in the unmatched cohort. RT radiotherapy, POS postoperative survival, LFFI locoregional failure-free interval, DMFI distant metastasis-free interval
Fig. 2
Fig. 2
a POS, b LFFI, and c DMFI for patients who did or did not receive neoadjuvant radiotherapy in the matched cohort. RT radiotherapy, POS postoperative survival, LFFI locoregional failure-free interval, DMFI distant metastasis-free interval
Fig. 3
Fig. 3
Overall survival from the start date of neoadjuvant treatment for patients with borderline resectable or resectable pancreatic cancer who did or did not receive neoadjuvant radiotherapy in the a unmatched and b matched cohorts. RT radiotherapy, OS overall survival, NAT neoadjuvant treatment
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