Partial regression of a refractory gastric ulcer following abdominal radiotherapy during a sofalcone-containing combination regimen

Radiation-induced gastric ulcer is uncommon but can be persistent and difficult to heal, particularly in patients receiving ongoing multimodality cancer treatment. We report a 68-year-old man with pancreatic ductal adenocarcinoma who developed a refractory antral ulceration after upper abdominal radiotherapy during intermittent chemotherapy. High-dose pantoprazole, rebamipide, Kangfuxin liquid, and subsequent vonoprazan achieved bleeding control but failed to induce healing. After sofalcone was added, postprandial pain improved substantially, and serial endoscopy showed regression of the ulcer from 2.0×1.8 cm to 0.6×0.8 cm. This case highlights the therapeutic challenge of post-radiation gastric ulceration and supports further study of repair-directed therapy.