Outcomes of neoadjuvant chemoradiation versus chemotherapy alone for resected distal pancreatic adenocarcinoma
In brief
Chemoradiation before distal pancreatic surgery linked to 8 months longer survival
In a national database study of 284 patients, those who received chemotherapy plus radiation before surgery had a median survival of 35 months, compared with 27 months for chemotherapy alone. Chemoradiation was also linked to more tumor downstaging and less progression, but this retrospective comparison cannot prove it caused better outcomes; prospective trials are needed.
- Journal
- HPB : the official journal of the International Hepato Pancreato Biliary Association (Q1)
- Published
- 15 October 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Devanshi D Patel, Hamidreza Hosseinpour, Ahmad B Abdulkarim, Huibo Shao, Stephen W Behrman
- PMID
- 42966682
- DOI
- 10.1016/j.hpb.2026.10.001
Why clinicians should know about it
- Picked for Radiation Oncology (paper of the day, 2 November 2026): Compares neoadjuvant chemoradiation with chemotherapy in resectable pancreatic cancer
Abstract
BACKGROUND: Evidence comparing neoadjuvant chemoradiation (nCRT) with chemotherapy alone (nCT) for pancreatic ductal adenocarcinoma (PDAC) primarily concerns pancreatic head tumors. This study evaluated outcomes after distal resection. METHODS: The National Cancer Database was retrospectively reviewed for patients undergoing distal pancreatectomy and splenectomy following neoadjuvant therapy for PDAC during 2005-2019. Outcomes included pathologic downstaging, disease progression, and overall survival. RESULTS: Among 284 patients, 142 received each treatment. Baseline characteristics were comparable, although nCRT patients had higher clinical stage (p = 0.004). Overall, pathologic downstaging occurred in 36.3% of all patients. Compared with nCT, nCRT was associated with greater pathologic downstaging (47.2% versus 25.4%; p < 0.001) and less disease progression (7.7% versus 19%; p = 0.005). On multivariable analysis, nCRT was associated with increased odds of downstaging (adjusted OR 2.57, 95% CI 1.55-4.27; p < 0.001) and decreased odds of progression (adjusted OR 0.44, 95% CI 0.34-0.72; p = 0.004). Overall survival was longer with nCRT (35 versus 27 months; adjusted HR 0.74, 95% CI 0.56-0.99; p = 0.039). CONCLUSIONS: Among patients undergoing distal resection for PDAC, nCRT was associated with improved pathologic response, reduced progression, and longer survival compared with nCT. These findings support considering radiation within multidisciplinary treatment of pancreatic body and tail tumors and highlight the need for prospective trials.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.