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Peer-reviewedCC BY 4.0Annals of Gastroenterological Surgery

Impact of Histopathological Response on Outcomes After Surgical Resection Following Carbon‐Ion Radiotherapy for Pancreatic Cancer With Arterial Involvement

  • Kenichiro Araki1
  • Norio Kubo1
  • Yuhei Miyasaka2,3
  • Hayato Ikota4
  • Ryo Muranushi1
  • Mariko Tsukagoshi1
  • Takamichi Igarashi1
  • Masahiko Okamoto2,3,5
  • Tatsuya Ohno2,3
  • Ken Shirabe1
5 affiliations
  1. 1Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science Gunma University Graduate School of Medicine Maebashi Gunma Japan
  2. 2Department of Radiation Oncology Gunma University Graduate School of Medicine Maebashi Gunma Japan
  3. 3Gunma University Heavy Ion Medical Center Maebashi Gunma Japan
  4. 4Clinical Department of Pathology Gunma University Hospital Maebashi Gunma Japan
  5. 5Department of Radiation Oncology, International Medical Center Saitama Medical University Saitama Japan
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Abstract

Aim: Carbon‐ion radiotherapy (CIRT) provides superior dose distribution and higher biological effectiveness than conventional X‐ray radiotherapy and has emerged as a promising component of multidisciplinary treatment for advanced pancreatic ductal adenocarcinoma (PDAC). However, evidence regarding surgical resection after CIRT remains limited. In this study, we aimed to evaluate the feasibility, histopathological therapeutic response, and oncological outcomes of pancreatic resection after CIRT‐based multimodal treatment.

Methods: We retrospectively analyzed 12 patients with borderline resectable pancreatic cancer with arterial involvement (BR‐A) or unresectable locally advanced PDAC (UR‐LA), who underwent surgical resection following CIRT at our institution between January 2016 and June 2025. The surgical outcomes, perioperative morbidity, pathological therapeutic responses, and survival outcomes were assessed.

Results: Surgical resection after CIRT was feasible in all patients. The procedures included pancreaticoduodenectomy (n = 5), distal pancreatectomy (n = 2), and distal pancreatectomy with celiac axis resection (n = 5). R0 resection was achieved in 11 patients (92%) and no pathological lymph node metastasis was identified. A marked histopathological response (Evans Grades III–IV) was observed in 83% of patients. No local recurrences were observed in the CIRT irradiation field. The 3‐year progression‐free survival and overall survival (OS) rates calculated from treatment initiation were 74.1% and 79.5%, respectively, whereas the corresponding 3‐year recurrence‐free survival and OS rates calculated from surgical resection were 47.6% and 50.8%, respectively.

Conclusions: Surgical resection following CIRT‐based multimodal treatment is feasible and safe, achieving a favorable histopathological response and durable local control in selected patients with PDAC with arterial involvement.

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Cite

BibTeXRIS
BibTeX
@article{araki2026impact,
  title = {{Impact of Histopathological Response on Outcomes After Surgical Resection Following Carbon‐Ion Radiotherapy for Pancreatic Cancer With Arterial Involvement}},
  author = {Kenichiro Araki and Norio Kubo and Yuhei Miyasaka and Hayato Ikota and Ryo Muranushi and Mariko Tsukagoshi and Takamichi Igarashi and Masahiko Okamoto and Tatsuya Ohno and Ken Shirabe},
  journal = {Annals of Gastroenterological Surgery},
  year = {2026},
  month = aug,
  doi = {10.1002/ags3.70259},
  url = {https://doi.org/10.1002/ags3.70259},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Impact of Histopathological Response on Outcomes After Surgical Resection Following Carbon‐Ion Radiotherapy for Pancreatic Cancer With Arterial Involvement
AU  - Kenichiro Araki
AU  - Norio Kubo
AU  - Yuhei Miyasaka
AU  - Hayato Ikota
AU  - Ryo Muranushi
AU  - Mariko Tsukagoshi
AU  - Takamichi Igarashi
AU  - Masahiko Okamoto
AU  - Tatsuya Ohno
AU  - Ken Shirabe
PY  - 2026
DA  - 2026/08/02
JO  - Annals of Gastroenterological Surgery
DO  - 10.1002/ags3.70259
UR  - https://doi.org/10.1002/ags3.70259
AB  - Aim: Carbon‐ion radiotherapy (CIRT) provides superior dose distribution and higher biological effectiveness than conventional X‐ray radiotherapy and has emerged as a promising component of multidisciplinary treatment for advanced pancreatic ductal adenocarcinoma (PDAC). However, evidence regarding surgical resection after CIRT remains limited. In this study, we aimed to evaluate the feasibility, histopathological therapeutic response, and oncological outcomes of pancreatic resection after CIRT‐based multimodal treatment.  Methods: We retrospectively analyzed 12 patients with borderline resectable pancreatic cancer with arterial involvement (BR‐A) or unresectable locally advanced PDAC (UR‐LA), who underwent surgical resection following CIRT at our institution between January 2016 and June 2025. The surgical outcomes, perioperative morbidity, pathological therapeutic responses, and survival outcomes were assessed.  Results: Surgical resection after CIRT was feasible in all patients. The procedures included pancreaticoduodenectomy (n = 5), distal pancreatectomy (n = 2), and distal pancreatectomy with celiac axis resection (n = 5). R0 resection was achieved in 11 patients (92%) and no pathological lymph node metastasis was identified. A marked histopathological response (Evans Grades III–IV) was observed in 83% of patients. No local recurrences were observed in the CIRT irradiation field. The 3‐year progression‐free survival and overall survival (OS) rates calculated from treatment initiation were 74.1% and 79.5%, respectively, whereas the corresponding 3‐year recurrence‐free survival and OS rates calculated from surgical resection were 47.6% and 50.8%, respectively.  Conclusions: Surgical resection following CIRT‐based multimodal treatment is feasible and safe, achieving a favorable histopathological response and durable local control in selected patients with PDAC with arterial involvement.
SN  - 2475-0328
ER  -