ESTRO 2025 - Abstract Book

S1811

Clinical – Upper GI

ESTRO 2025

2801

Digital Poster Results of the EORTC survey on the management of non-metastatic pancreatic adenocarcinoma: a focus on radiotherapy. Christelle Bouchart 1 , Matthieu Delaye 2 , Ingrid Garajova 3 , Florence Huguet 4 , Cindy Neuzillet 2 1 Department of Radiation Oncology, HUB - Jules Bordet Institute, Brussels, Belgium. 2 Department of Medical Oncology, Institut Curie, Paris, France. 3 Medical Oncology Unit, University Hospital of Parma, Parma, Italy. 4 Department of Radiation Oncology, Hopital Tenon - Institut universitaire de cancérologie, Paris, France Purpose/Objective: Optimal management of pancreatic ductal adenocarcinoma (PDAC) remains debated. The aim of this survey was to explore current clinical practices for the management of non-metastatic PDAC at European level with a particular focus on radiotherapy (RT). Material/Methods: The survey was developed by a multidisciplinary team (radiation oncologists [RO], medical oncologists and gastroenterologists) under the aegis of the EORTC digestive group. Survey included 75 items, including 23 on RT and the Google Form platform was used (Google, Mountain View, USA). The questionnaire was distributed between March and June 2024 through EORTC and several national societies of digestive cancer. It was addressed to gastroenterologists, medical oncologists, RO and digestive surgeons practicing in Europe. Results: A total of 83 practitioners from 16 European countries responded to the survey, 23 of them were RO. A majority of participants had a very experienced profile, managing PDAC for more than 10 years. In case of resectable PDAC, 74% of respondents opted for surgery first while 22% proposed neoadjuvant chemotherapy (mainly FOLFIRINOX). For borderline resectable PDAC, respondents opted for an induction chemotherapy followed by RT as preferred strategy in 25% (57% with SBRT and 43% with chemoRT) and in 70% for induction chemotherapy alone. In this case, RT was proposed to be added in a second time after chemotherapy by 37% of the panel, mostly in case of poor response or persistence of vascular contact (particularly arterial). After the end of RT, the minimal and maximal waiting time allowed before surgical exploration were a median of 4 and 8 weeks, respectively. For locally advanced PDAC, the panel’s preferred choice was induction chemotherapy followed by chemoRT in 42% followed by chemotherapy alone in 35%, and chemotherapy followed by SBRT in 23%. Induction chemotherapy was most often performed for 6 (43%) or 4 months (30%). Respondents proposed a cancellation of RT after chemotherapy and immediate surgical exploration in case of very good response without remaining vascular contact in 77% and following a normalization of CA19-9 in 42%. Conclusion: This survey highlighted the great heterogeneity in PDAC current clinical practices, particularly for RT. Many questions persist regarding the management of these patients, especially on the reconsideration of the planned therapeutic strategy often proposed according to the evolution under chemotherapy, a question not explored in clinical trials. This study demonstrates the need to establish work to harmonize practices in Europe and could serve as a basis for the design of future European clinical trials.

Keywords: Pancreatic cancer, neoadjuvant treatment