Use of Phosphorus-32 Microparticles for Downstaging Locally Advanced Pancreatic Cancer to Resection: A Case Report

Unresectable locally advanced pancreatic cancer (LAPC) is managed with first-line chemotherapy or induction chemotherapy with consolidative chemoradiotherapy. Phosphorus-32 (³²P) microparticles serve as a brachytherapy device, approved for use in LAPC, that has the advantage of delivering radiation directly to the tumour while reducing the risk of damage to nearby tissue or organs. The case of a 72-year-old woman with an unresectable pancreatic adenocarcinoma in the head of the pancreas with long-term survival following downstaging to resection with ³²P microparticles is presented here. The patient received first-line gemcitabine+nab-paclitaxel chemotherapy, with a partial response occurring during the first three cycles of chemotherapy; however, the tumour remained unresectable and subsequently increased in size after a justified delay in chemotherapy. ³²P microparticle implantation was conducted as planned at the end of cycle 4, and no device- or procedure-related adverse events were observed. Gemcitabine+nab-paclitaxel chemotherapy was continued, and computed tomography (CT) imaging during cycle 6 (6.8 months after diagnosis) revealed stabilisation of tumour size and a slight decrease in the density of the pancreatic mass. The surgical team determined that surgery could be feasible at this stage. Surgical resection by an open Whipple procedure was successfully completed 7.9 months after diagnosis. As of January 2026, the patient remains alive without evidence of disease 50 months after diagnosis and 42 months post-resection. This case study shows that the addition of ³²P microparticles to first-line gemcitabine+nab-paclitaxel chemotherapy, in a patient with unresectable LAPC, is associated with not only disease stabilisation but also conversion to surgical resection, with no associated radiation-related adverse events.