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Presurgical Ablative Radiation Is Associated with Local Control and Immune Response in Pancreatic Cancer
Peter Q Leung1, Eslam A Elghonaimy1, Ahmed M Elamir1
1Department of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center (UTSW), Dallas, Texas.
Summary
Adding stereotactic ablative radiotherapy (SAbR) to neoadjuvant chemotherapy for pancreatic cancer improved pathological outcomes and local control. This approach maintained survival and induced a unique immune response, warranting further investigation for clinical benefits.
Area of Science:
- Oncology
- Surgical Oncology
- Radiation Oncology
Background:
- Pancreatic cancer treatment often involves neoadjuvant chemotherapy.
- The role of ablative radiotherapy in conjunction with chemotherapy requires further elucidation.
- Understanding molecular responses can guide future therapeutic strategies.
Purpose of the Study:
- To compare outcomes and molecular characteristics in pancreatic cancer patients.
- To assess the impact of neoadjuvant chemotherapy with or without stereotactic ablative radiotherapy (SAbR).
- To identify molecular differences induced by SAbR for future treatment guidance.
Main Methods:
- A single-institution cohort study of pancreatic cancer patients (2012-2023).
- Comparison of therapeutic responses between neoadjuvant chemotherapy alone and with SAbR.
- RNA sequencing for molecular response assessment and Cox modeling for outcome analysis.
Main Results:
- SAbR group showed better post-treatment pathology despite more advanced baseline disease.
- SAbR improved locoregional recurrence-free survival (HR=0.24) and reduced local failure risk in cases of arterial involvement.
- Gene set enrichment analysis revealed immune activation, with specific cell signatures correlating with local control.
Conclusions:
- Neoadjuvant SAbR improves pathological outcomes and local control in pancreatic cancer.
- SAbR maintains survival and induces a distinct immune response.
- Further well-powered studies are necessary to confirm the clinical benefits of SAbR.
