In a landmark development, scientists at the Johns Hopkins Kimmel Cancer Center have achieved a 95% reduction in pancreatic cancer recurrence using a precision technique known as intraoperative radiation therapy (IORT). The breakthrough findings, presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting, represent a major advance in the management of pancreatic cancer, a disease long known for its poor prognosis, high recurrence rates, and limited curative options.
Pancreatic cancer is the third leading cause of cancer related deaths in the United States, with a five-year survival rate of less than 13%. Even after surgical removal, nearly 80% of patients experience recurrence within two years, often due to microscopic disease left behind in difficult to reach areas. The new Johns Hopkins study offers renewed hope by demonstrating that a carefully targeted intraoperative radiation approach can drastically lower these relapse rates.
The innovative IORT technique delivers a focused dose of radiation directly to high-risk tissues during surgery, immediately after the tumor is removed. In the reported clinical trial, 20 patients with borderline resectable or locally advanced pancreatic cancer, conditions once considered inoperable due to tumor involvement with nearby blood vessels, underwent a multimodal treatment protocol. Each patient first received chemotherapy and targeted external beam radiation to shrink the tumor, followed by surgical resection combined with intraoperative radiation.
During surgery, a robotic-guided system enabled surgeons and radiation oncologists to deliver microscopic radioactive beads through catheters to the areas most susceptible to residual cancer spread. Only one patient experienced local recurrence within two years, a dramatic improvement compared to historical data where most patients relapse despite aggressive treatment.
Researchers attribute this success to precise targeting of a high-risk region known as the Baltimore Triangle, a dense fatty zone above the pancreas identified in earlier Johns Hopkins studies as a critical pathway for cancer cell migration along nerves. Previous interventions focusing on this region had already reduced local recurrence rates from 47% to 12%, but the addition of IORT pushed that figure down to an unprecedented 5%, the lowest ever reported.
The team achieved this by combining pre-surgical external radiation with intraoperative delivery of concentrated radiation directly into the Baltimore Triangle, while carefully sparing surrounding healthy tissues. Partial surgical removal of the duodenum provided a safe access route for the targeted radiation procedure. According to the researchers, this dual phase radiation strategy allows maximum tumoricidal effect in an area previously considered unreachable without causing collateral damage.
Supporting evidence from Mischinger and colleagues aligns with these observations, suggesting that patients who undergo IORT experience longer disease free and overall survival, with reduced local recurrence and no significant increase in postoperative complications compared to those who receive conventional therapy alone.
The single recurrence observed in the Johns Hopkins trial occurred in a section of the Baltimore Triangle currently beyond the reach of existing delivery technology. The research team is developing next generation radiation delivery systems designed to improve precision and achieve complete local control.
Johns Hopkins investigators are now preparing to launch a multicenter clinical trial in collaboration with leading cancer centers across the United States. The goal is to validate these findings in a larger population and potentially establish intraoperative radiation therapy as a new national standard of care for patients with pancreatic cancer.
Experts in oncology have hailed this achievement as a transformative step toward improving survival and quality of life in a disease that has long resisted major therapeutic breakthroughs. If replicated in larger trials, IORT could redefine surgical oncology practice by turning once inoperable cases into candidates for curative treatment.
Reference
- Reddy AV, Sehgal S, Mao S, Hill C, Lin T, Paparoidamis G, et al. A Safety Study of Intraoperative Radiation Therapy Following Stereotactic Body Radiation Therapy and Multi-Agent Chemotherapy in the Treatment of Localized Pancreatic Adenocarcinoma. International Journal of Radiation Oncology, Biology, Physics. 2025 Sept 1;123(1):S131.
- Mischinger HJ, Wagner D, Werkgartner G, Bajric T, Winkler P, Stranzl-Lawatsch H, et al. Intraoperative radiation therapy in pancreatic cancer. European Journal of Surgical Oncology. 2022 Feb 1;48(2):e136.