Targeted intraoperative radiation slashes pancreatic cancer recurrence to 5%

Editor's Note

A Johns Hopkins team is reporting unprecedented success in preventing pancreatic cancer recurrence by combining pre-surgical and intraoperative radiation focused on a key anatomical area near the pancreas, News Medical Life Sciences October 30 reports. Citing a Johns Hopkins Medicine preliminary study, this approach reportedly reduced recurrence around the pancreas to just 5%, believed to be the lowest rate ever reported for this patient population.

The study, presented at the American Society for Radiation Oncology meeting in September 2025, enrolled 20 patients with borderline resectable or locally advanced pancreatic cancer. Participants first received chemotherapy and targeted radiation to shrink tumors from nearby blood vessels, allowing for surgical removal. During surgery, a robotic device delivered a second dose of pinpoint radiation using radioactive beads inserted through catheters.

Researchers targeted a nerve-rich zone above the pancreas dubbed the “Baltimore triangle,” a common site of recurrence. Only one patient in the study experienced a recurrence within 24 months, marking a major stride in a cancer type with historically poor outcomes. Previously, even with pre-surgical radiation, recurrence rates hovered around 47% at 2 years. Initial targeting of the Baltimore triangle dropped this to 12% but revealed lingering risk in that specific region.

The refined approach leverages intraoperative radiation after tumor removal, which becomes more feasible when surgeons remove part of the adjacent duodenum, improving access to the target area. The lone recurrence occurred in a pocket of the Baltimore triangle not fully accessible during surgery. Researchers are now developing methods to reach this area. Once refined, they plan to collaborate with other institutions for a larger clinical trial.