PHILADELPHIA (May 6, 2025) — A study presented today by researchers at Fox Chase Cancer Center finds that the type of therapy a patient receives before surgery for pancreatic ductal adenocarcinoma has more of an impact on postoperative outcomes and survival than the duration of treatment.
“We found that treatment modality is the key factor,” said Emily Papai, MD, research fellow at Fox Chase Cancer Center, surgery resident at the Lewis Katz School of Medicine at Temple University, and first author on the study. “Specifically, total neoadjuvant therapy — a combination of chemotherapy and radiation also known as TNT — was the most effective for overall survival.”
The standard approach for treating pancreatic ductal adenocarcinoma involves neoadjuvant therapy, in which therapeutic agents are administered before surgery. Research increasingly supports TNT as the optimal preoperative strategy. Papai and her team, led by Sanjay S. Reddy, MD, FACS, Division Chief of Surgical Oncology and Co-Director of the Marvin & Concetta Greenberg Pancreatic Cancer Institute at Fox Chase, sought to determine whether TNT’s effectiveness is due to the combination of chemotherapy and radiation itself or simply related to the duration of treatment.
The researchers analyzed anonymous records for 213 Fox Chase patients with pancreatic ductal adenocarcinoma who underwent surgery between 2012 and 2024. Patients were divided based on the type of treatment they received before surgery: no treatment, chemotherapy only, radiation therapy only, or TNT. They then analyzed surgical outcomes and long-term survival, assessing both treatment type and duration.
The findings confirmed that TNT is the most effective neoadjuvant treatment, independent of its longer duration. Additionally, they found that while at least five weeks of preoperative therapy is beneficial, extending treatment beyond a standard regimen does not yield additional advantages.
“A patient might wonder if continuing chemotherapy instead of going on to surgery will improve their chances of surviving. That answer is no,” said Papai. She emphasized that while her team found a benefit to receiving therapy prior to surgery, delaying surgery indefinitely is not beneficial. “Right now, the research in our field shows that surgery is the only treatment with curative potential. So, when feasible, surgery is still important to pursue.”
The study, “Decoding the Impact of Neoadjuvant Therapy Modality and Duration on Prognostic Factors in Pancreatic Ductal Adenocarcinoma,” was presented at Digestive Disease Week (DDW), held in San Diego May 3-6.