Pancreatic cancer is one of the worst types of cancer worldwide. It is also an increasing health concern in South Asia, with low survival rates. A recent study published in Clinical Cancer Research gives new hope: combining targeted radiation with chemotherapy before surgery may lessen the likelihood of the cancer returning at the initial spot. 

Pancreatic ductal adenocarcinoma is the most frequent kind of pancreatic cancer. It is recognised for its aggressive character and high likelihood of recurrence even after treatment. According to the World Health Organisation's International Agency for Research on Cancer, pancreatic cancer is one of the top ten causes of cancer death worldwide. Although the general incidence in South Asia is lower than in Western countries, survival rates remain low due to late diagnosis and restricted access to modern therapies. 

According to main author and radiation oncologist Dr Todd Aguilera, "Pancreatic ductal adenocarcinoma is extremely difficult to treat because even after chemotherapy and surgery, tumours often grow back, many times at the original site." 

The study examined 181 individuals treated at UT Southwestern Medical Centre and Parkland Health from 2012 to 2023. Before surgery, all patients were given chemotherapy to reduce their tumours, but some additionally got stereotactic ablative radiotherapy (SAbR). 

SAbR delivers large doses of radiation to the tumour with extreme precision while preserving neighbouring healthy tissues. It differs from regular radiation therapy, which often uses lower doses spread out across multiple sessions. The goal is to deliver a greater blow to the malignancy while minimising unwanted effects. 

The study discovered that individuals who took SAbR had superior local control of their cancer—meaning the tumours were less likely to recur in the same location—despite starting with higher advanced disease. 

However, overall survival rates (the amount of time patients survived following therapy) were comparable between those who received SAbR and those who did not. This underlines an important point: whereas patients may not live longer overall, minimising local recurrence can significantly enhance their quality of life. Tumour regrowth at the original site can result in considerable pain and other problems. 

"This matters because local tumour regrowth causes significant suffering for patients," Dr Aguilera stated. "As systemic therapies continue to improve, the burden of local recurrence becomes even more prominent – and more important to address." 

Aside from the clinical findings, researchers performed RNA sequencing (a tool for determining which genes are active in cells) on tumour samples from 43 individuals. They discovered that SAbR could activate the body's immune system to fight cancer. They discovered an increase in lymphocytes, which are white blood cells that help fight infections and malignancies, in the tumours of patients treated with SAbR. 

This finding is significant because it suggests a potential future strategy: combining high-dose radiation with immunotherapy (treatments that aid the immune system in fighting cancer). Immunotherapy has transformed treatment for tumours such as melanoma and lung cancer, but it has had limited effectiveness in pancreatic cancer. 

"While further study is needed, it's possible that there is potential in combining high-dose ablative radiation with immunotherapies," she said. 

Pancreatic cancer is a significant challenge in South Asia. According to the Indian Council of Medical Research, it has one of the lowest survival rates of any major malignancy in India. Many individuals are diagnosed too late for surgery to be successful. Efforts to enhance early detection, increase access to advanced treatments, and develop new techniques such as SAbR with immunotherapy are critical. 

This study demonstrates that, even when a treatment is difficult to obtain, improved local control can alleviate suffering. As cancer therapies become increasingly personalised, combining chemotherapy, targeted radiotherapy, and immunotherapy may provide new hope to those fighting this deadly disease.