Back to 2026 Abstracts
Neoadjuvant Chemotherapy Versus Neoadjuvant Chemoradiotherapy Among Patients with Pancreatic Ductal Adenocarcinoma Undergoing Pancreatectomy: A Target Trial Emulation
Abolfazl Salari, MD1, Mario O'Connor, MD, MPH1, Chukwuma N. Eruchalu, MD1, Emily E. Witt, MD, MSc1, Mengyuan Ruan, MS1, George Molina, MD, MPH1 1.Division of Surgical Oncology, Department of Surgery, Mass General Brigham, Boston, MA, USA
Background: Neoadjuvant chemotherapy (NAC) followed by pancreatectomy is standard treatment for borderline resectable and locally advanced pancreatic ductal adenocarcinoma (PDAC). Whether adding radiotherapy to NAC provides additional benefit remains controversial. This study compared NAC with neoadjuvant chemoradiotherapy (NACRT) among patients with PDAC undergoing pancreatectomy using a target trial emulation (TTE) framework. Methods: Using the National Cancer Database (2010–2022), we identified patients with PDAC who received NAC or NACRT before pancreatectomy. A clone-censor-weight TTE approach was used. Patients were cloned into both treatment strategies at baseline, censored upon deviation from assigned therapy, and reweighted using inverse probability of censoring weights (IPCW). Results: Of 42,441 patients cloned into both arms, 2,456 (5.8%) remained adherent to their assigned treatment strategy, including 1,733 (70.6%) in the NAC arm and 723 (29.4%) in the NACRT arm. In the IPCW-weighted TTE analysis, 1-year overall survival (OS) was higher with NACRT (85.1%, 95% CI: 83.5%–87.2%) than NAC (82.2%, 95% CI: 80.5%–83.5%), an absolute difference of −2.9% (95% CI: −5.3% to −0.9%). No significant OS differences were observed at any other time point (Table 1). Median OS was similar: 26.7 months (95% CI: 25.3–28.9) for NAC versus 26.5 months (95% CI: 24.4–29.3) for NACRT, with a difference of 0.2 months (95% CI: −3.0 to 3.1). Conclusion: Adding neoadjuvant radiotherapy to NAC was not associated with higher OS.
Back to 2026 Abstracts
