Multimodal Neoadjuvant Therapy for Pancreatic Ductal Adenocarcinoma (PDAC) With Vascular Involvement: What Is the Impact of Radiation on Perioperative Outcomes, Local Control, and Survival?

Dhruv J Patel; Lauren M Janczewski; Joseph H Cotler; George Molina; Brett L Ecker; David Bentrem; Shishir K Maithel; Mohamed E Abazeed; John P Hayes; Bryan Palis; Amanda B Francescatti; Ronald J Weigel; Judy Boughey; Lesly Dossett; Akhil Chawla

doi:10.1002/jso.70387

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Multimodal Neoadjuvant Therapy for Pancreatic Ductal Adenocarcinoma (PDAC) With Vascular Involvement: What Is the Impact of Radiation on Perioperative Outcomes, Local Control, and Survival?

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Multimodal Neoadjuvant Therapy for Pancreatic Ductal Adenocarcinoma (PDAC) With Vascular Involvement: What Is the Impact of Radiation on Perioperative Outcomes, Local Control, and Survival?

Dhruv J Patel, Lauren M Janczewski, Joseph H Cotler, George Molina, Brett L Ecker, David Bentrem, Shishir K Maithel, Mohamed E Abazeed, John P Hayes, Bryan Palis, …

Journal of surgical oncology

08/25/2026

DOI: 10.1002/jso.70387

PMID: 42640830

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Abstract

Neoadjuvant chemoradiation for PDAC with vascular invasion remains understudied. The aim of this study is to compare neoadjuvant chemotherapy with chemoradiation (NAC + CRT) versus neoadjuvant chemotherapy (NAC) for PDAC with vascular involvement. The National Cancer Database was reviewed between 2018 and 2023, including patients with T4 PDAC initiating NAC or NAC + CRT. The primary outcome of overall survival (OS) was examined among unresected and resected cohorts. Secondary outcomes included pathologic complete response (pCR), node-negative (ypN0) pathology, and R0 resection. Multilevel logistic and Cox models were fit to identify factors associated with outcomes. In total, 2950 patients met inclusion, of which 1407 (47.7%) underwent NAC + CRT. In total, 1291 (44.4%) underwent surgery. Use of NAC + CRT declined by 2.8%/year (p < 0.001). Compared with NAC, use of NAC + CRT was associated with R0 resection (OR: 0.62, 95% CI: [0.43, 0.89], p = 0.010) and ypN0 (OR: 2.19, 95% CI: [1.63, 2.93], p < 0.001) but not pCR (OR: 1.78, 95% CI: [0.99, 3.20], p = 0.056). NAC + CRT was associated with improved OS among the full cohort (hazard ratio [HR]: 0.67, 95% CI: [0.60, 0.74], p < 0.001) but not the resected cohort (HR: 0.98, 95% CI: [0.81, 1.19], p = 0.848). Neoadjuvant chemoradiation for T4 PDAC yielded mixed effects on local response with no survival difference among patients undergoing resection.

Chemotherapy

pancreatic adenocarcinoma

neoadjuvant

radiation

Details

Title: Subtitle: Multimodal Neoadjuvant Therapy for Pancreatic Ductal Adenocarcinoma (PDAC) With Vascular Involvement: What Is the Impact of Radiation on Perioperative Outcomes, Local Control, and Survival?
Creators: Dhruv J Patel - American College of Surgeons
Lauren M Janczewski - Northwestern University
Joseph H Cotler - American College of Surgeons
George Molina - Brigham and Women's Hospital
Brett L Ecker - Northwestern University
David Bentrem - Northwestern University
Shishir K Maithel - Northwestern University
Mohamed E Abazeed - Northwestern University
John P Hayes - Northwestern University
Bryan Palis - American College of Surgeons
Amanda B Francescatti - American College of Surgeons
Ronald J Weigel - University of Iowa
Judy Boughey - Mayo Clinic
Lesly Dossett - University of Michigan
Akhil Chawla - Northwestern University
Resource Type: Journal article
Publication Details: Journal of surgical oncology
DOI: 10.1002/jso.70387
PMID: 42640830
ISSN: 0022-4790
eISSN: 1096-9098
Publisher: Wiley
Language: English
Electronic publication date: 08/25/2026
Academic Unit: Molecular Physiology and Biophysics; Surgery; Biochemistry and Molecular Biology
Record Identifier: 9985220840802771

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