2982 - Neoadjuvant Radiation Practice Patterns in Resected Pancreatic Ductal Adenocarcinoma at Academic Cancer Centers Participating in the Canopy Cancer Collective Learning Health Network

F. Fekrmandi¹, J. M. Bryant², B. K. Neilsen³, D. R. Cherry⁴, R. Myneni⁵, T. Ozgen⁶, T. Schneider⁷, N. K. Malik¹, R. Palm⁸, A. Raldow⁹, K. A. Goodman⁴, A. Narang⁵, R. Kumar⁵, M. Ghaly¹⁰, L. Cherkassky⁷, B. Calvo⁷, T. A. Aguilera¹¹, E. D. Miller¹², J. D. Murphy¹³, S. Apisarnthanarax¹⁴, M. Feng¹⁵, H. J. Roberts¹⁶, C. Stricker¹⁷, L. Tchelebi⁶, and J. M. Herman^10,17; ¹Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, ²H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL, ³Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, ⁴Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, ⁵Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, ⁶Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY, ⁷Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, ⁸Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, ⁹Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, ¹⁰Department of Radiation Medicine, Northwell, Lake Success, NY, ¹¹Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, ¹²Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, ¹³Department of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA, ¹⁴Department of Radiation Oncology, University of Washington/ Fred Hutchinson Cancer Center, Seattle, WA, ¹⁵University of California, San Francisco, San Francisco, CA, ¹⁶Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, ¹⁷1440 Foundation Canopy Cancer Collective, Scotts Valley, CA

Purpose/Objective(s): The role of neoadjuvant radiation therapy (NRT) for pancreatic ductal adenocarcinoma (PDAC) is poorly defined. The publication of the Phase II Alliance A021501 clinical trial (AT), evaluating the role of neoadjuvant SBRT for PDAC patients, may have resulted in a non-uniform shift in practice patterns across the country. Founded in 2019, the Canopy Cancer Collective (CCC) is the first oncology learning health network to improve PDAC outcomes and to discuss best practices. Herein, we report how NRT practice patterns (CCC database), and physician opinions (survey) were impacted by the AT. Materials/

Methods: A survey of the impact of A201501 on NRT SBRT practice patterns in PDAC was distributed to 17 radiation oncology (RO) faculty across 14 CCC sites. To assess the AT impact in a more objective manner, the CCC patient registry was also queried and the de-identified limited-field data was analyzed under CCC data sharing agreements.
Results: The survey was completed by 78% cancer centers and 82% RO faculty. Overall, 71.5% faculty reported no change in their confidence in benefit of NRT in borderline resectable PDAC patients due to the results of the AT, and 43% reported no impact on the utilization of neoadjuvant SBRT. Forty three percent reported decreased SBRT utilization and 14% no longer offer SBRT. The two latter groups reported favoring either dose-escalated (33%) or standard chemoradiation (44%) over SBRT. Fifty seven percent reported no impact on their utilization of pancreas SBRT for all PDAC patients and the remaining 43% reported offering SBRT less often. Among 4,512 PDAC patients recorded in the CCC registry between 1/2020 and 2/2024, the median age was 60.5 years (range 57-64). Fifty two percent of the patients were male and 85% had good performance status (ECOG 0-1). Among those, 608 patients had a surgery between 1/2020-12/2023 and 90 (15%) underwent NRT. Of those, 10% were staged resectable, 40% borderline resectable, and 37% locally advanced. SBRT was the NRT of choice in 50% of resectable, 60% of borderline resectable and 75% of locally advanced stages. The ratio of NRT to surgery has declined since 2020: 20% (9/44) in 2020, 15% (16/105) in 2021, 17% (44/253) in 2022, and 10% (21/206) in 2023. However, 69% (62/90) of these NRT patients were treated with SBRT and its utilization has consistently increased since 2020: 44% in 2020, 62% in 2021, 70% in 2022 and 80% in 2023.
Conclusion: There is less enthusiasm among ROs regarding NRT in PDAC, but when offered in our CCC sites, SBRT is increasingly chosen over conventional fractionation. There is a paucity of randomized neoadjuvant trials to address this area of ongoing debate.