Willing and ablative.

This cohort study reports on outcomes among 119 patients receiving ablative radiation for unresectable pancreatic cancer. Speaking of ablative, an important exclusion criteria was >5 cm of tumor contact with bowel, and target coverage was sacrificed to meet all constraints for organs at risk. Now, what’s meant by ablative? For this prospectively obtained cohort it meant anything that could achieve a biologically effective dose (BED) over 97 Gy including 67.5 Gy / 15 for targets with at least 1 cm separation from bowel and 75 Gy / 25 for the rest. Importantly, almost all (116/119) received induction chemo. Median survival from the time of diagnosis was 27 months and rates of locoregional failure at one and two years were 18% and 33%, respectively. In other words, outcomes were pretty great for these unresected pancreatic cancers. | Reyngold, JAMA Oncol 2021