Trend of Adjuvant Radiation in Resected Pancreatic Ductal Adenocarcinoma: Evaluation of RTOG 0848 with a Large National Database

Clinical Snapshot

Key Findings

• P Value: p < 0.001

• Effect Size: Hazard ratio 0.791 for mortality reduction with adjuvant radiation

• Primary Outcome: Overall survival in margin-positive, node-negative patients

• Nnt Or Sensitivity: 5.6 month median survival improvement (28.6 vs 23.0 months)

• Confidence Interval: 95% CI: 0.7-0.9

Clinical Application

Adjuvant radiation readily available in Australian cancer centres with established multidisciplinary teams Findings support current Cancer Australia guidelines emphasizing multidisciplinary care; relevant to PBS-funded radiation therapy services and NCCN-aligned Australian practice patterns Patients with resected pancreatic ductal adenocarcinoma, particularly those with margin-positive, node-negative disease

Abstract

PURPOSE: Adjuvant radiation (AR) remains a controversial treatment modality for pancreatic ductal adenocarcinoma (PDAC). This study aimed to evaluate the findings of the RTOG 0848 trial assessing the benefits of adjuvant radiation in node-negative disease utilizing a national database. METHODS: Utilizing the National Cancer Database, all patients diagnosed with non-metastatic PDAC, who underwent pancreatectomy, were included (2004-2019). The trend of adjuvant radiation utilization was evaluated. Overall survival in a cohort of patients mimicking the RTOG 0848 protocol was examined as were clinicodemographic and pathologic predictors of adjuvant radiation. RESULTS: Overall rates of adjuvant radiation decreased from 45 to 12%, while neoadjuvant radiation rates simultaneously increased from 4 to 12%. Positive margins and nodal disease were the strongest predictors of adjuvant radiation receipt (OR 1.7[ 95% CI: 1.6-1.7] p < 0.001 and OR: 1.1 [95% CI: 1.1-1.2] p < 0.001; respectively). Both high-risk pathologic groups experienced a decline in the use of adjuvant radiation over time, even after exclusion of patients who received neoadjuvant radiation. After application of the RTOG 0848 criteria, improved overall survival was observed in patients with node-negative and positive margins (adjuvant radiation: 28.6 [95% CI: 25.4-31.8] vs 23.0 [95% CI: 19.4-26.7] months; p = 0.005). In the margin positive cohort, adjuvant radiation was significantly associated with reduced mortality (HR: 0.791 [95% CI: 0.7-0.9]; p < 0.001). CONCLUSION: Evaluation of RTOG 0848 in the setting of real-world data indicates a role for adjuvant radiation for patients with margin-positive, node-negative pancreatic cancer. This highlights the essential role of multidisciplinary discussions regarding patients with PDAC care.

References

1. 1.Dickey, E. M., Blansfield, J., Hoffman, R. L., Jiang, J. M., & Amini, N. (2026). Trend of Adjuvant Radiation in Resected Pancreatic Ductal Adenocarcinoma: Evaluation of RTOG 0848 with a Large National Database. Journal of Gastrointestinal Cancer. https://doi.org/10.1016/s1470-2045(25)00363-8