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Adjuvant Radiotherapy After Pancreaticoduodenectomy for Margin-Negative, Node-Positive Pancreatic Ductal Adenocarcinoma: A Nationwide Analysis
Journal article   Peer reviewed

Adjuvant Radiotherapy After Pancreaticoduodenectomy for Margin-Negative, Node-Positive Pancreatic Ductal Adenocarcinoma: A Nationwide Analysis

Muhammad Muntazir Mehdi Khan, Edward Anthony Joseph, Muhammad Anees, Erin Grayhack, Yue Yin, Paul Renz, Sricharan Chalikonda, David L. Bartlett and Casey J. Allen
Annals of surgical oncology
28 Mar 2026
DOI: https://doi.org/10.1245/s10434-026-19566-5
PMID: 41903020

Abstract

Life Sciences & Biomedicine Science & Technology Oncology Surgery
Background The role of adjuvant radiotherapy (adj-XRT) for patients with margin-negative (R0), node-positive (N+) pancreatic adenocarcinoma (PDAC) after pancreaticoduodenectomy (PD) remains controversial. This study assessed the impact of adj-XRT on overall survival (OS) for PDAC patients who underwent R0N+ PD. Methods The study queried a national database to identify R0N+ (stage IIB-III) patients who underwent PD for PDAC between 2004 and 2019. Propensity score-matching, based on a multivariate regression model predicting the use of adj-XRT, was used to match patients who received adj-XRT with those who did not. Results The study analyzed a cohort of 20,974 patients with 51.2% male (n = 10,735) and 81.7% white (n = 17,144) patients. The mean age was 65.5 +/- 9.8 years. Of these patients, 92.8% (n = 18,008) had stage IIB and 7.2% (n = 1407) had stage-III disease. The median OS for the overall cohort was 25.1 months (range, 14.1-48.3) months. The patients in the adj-XRT cohort were younger (63.8 +/- 9.6 vs 66.3 +/- 9.8 years; p < 0.001) and predominantly male (52.7% vs 50.4%; p = 0.002), with a Charlson-Deyo score of 1 or lower (92.4% vs 89.5%; p < 0.001. After propensity score-matching, the matched cohorts were similar with respect to patient age, race, sex, location, Charlson-Deyo score, and stage of disease (all p > 0.050). The patients who received adj-XRT had better median OS (26.0 months [range, 13.7-47.6 months] vs 24.1 months [range, 15.6-53.1 months]; p < 0.001). Adj-XRT was associated with improved median OS (26.0 months [range, 15.6-53.4 months] vs 24.0 months [range, 13.7-47.6 months]; p < 0.001) in stage IIB, but not in stage III (median, 25.7 months [range, 15.4-45.4 months] vs 25.5 months [range, 13.9-41.1 months]) patients. Conclusions Adj-XRT after R0N+ PD is associated with a modest survival benefit for stage IIB patients, but showed no difference for patients with advanced locoregional PDAC.

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