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Background <p>Pancreatic ductal adenocarcinoma (PDAC) is a major cause of cancer-related deaths in Australia, with a 5-year survival rate of less than 13%. The liver is the most common site of PDAC metastasis, and is observed in over 50% of cases. Standard chemotherapy, including regimens such as FOLFIRINOX or nab-paclitaxel plus gemcitabine, offer limited survival benefits, with median survival rates typically below one year. Selective internal radiation therapy (SIRT) with Yttrium-90 (90Y) microspheres is used to target liver metastases, but the optimal chemotherapy companion for SIRT in metastatic PDAC remains unknown.</p> Methods <p>We conducted a retrospective audit of 32 patients with metastatic PDAC treated with SIRT and chemotherapy, and evaluated the clinical outcomes associated with platinum-based versus non-platinum-based regimens.</p> Results <p>Patients who received platinum-based chemotherapy alongside SIRT had a median PFS of 10 months, compared to 2 months in those treated with non-platinum-based regimens. Stratified analysis revealed that patients receiving platinum-based chemotherapy in the first-line setting achieved a median post-SIRT survival of 16 months, compared to 4 months for those treated in later lines. For non-platinum-based regimens, median post-SIRT survival was 9 months in the first-line and 6 months in later lines. Median OS from Stage IV diagnosis was 17 months for patients with liver-only metastases and 15 months for those with additional extra-hepatic disease, suggesting that liver disease burden remains a dominant driver of outcomes.</p> Conclusions <p>These findings describe survival outcomes among patients treated with SIRT and chemotherapy for metastatic PDAC in a real-world setting. Longer observed survival was seen in patients who received platinum-based chemotherapy alongside SIRT, particularly in the first-line setting. Given the descriptive design and small sample size, these findings should be interpreted as hypothesis-generating and may inform future prospective evaluation of SIRT–chemotherapy combinations.</p>

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A retrospective analysis of Selective Internal Radiation Therapy (SIRT) and chemotherapy for metastatic pancreatic adenocarcinoma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月6日

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  • Sue S. Thang,
  • Vijayaragavan Muralidharan,
  • Manfred Spanger,
  • Patrick Page,
  • Adrian Fox,
  • Sean Mackay,
  • Lisa Miller,
  • Raffiela Garcia,
  • Ashleigh R. Poh,
  • Caroline Le,
  • Prasad Cooray

摘要

Background

Pancreatic ductal adenocarcinoma (PDAC) is a major cause of cancer-related deaths in Australia, with a 5-year survival rate of less than 13%. The liver is the most common site of PDAC metastasis, and is observed in over 50% of cases. Standard chemotherapy, including regimens such as FOLFIRINOX or nab-paclitaxel plus gemcitabine, offer limited survival benefits, with median survival rates typically below one year. Selective internal radiation therapy (SIRT) with Yttrium-90 (90Y) microspheres is used to target liver metastases, but the optimal chemotherapy companion for SIRT in metastatic PDAC remains unknown.

Methods

We conducted a retrospective audit of 32 patients with metastatic PDAC treated with SIRT and chemotherapy, and evaluated the clinical outcomes associated with platinum-based versus non-platinum-based regimens.

Results

Patients who received platinum-based chemotherapy alongside SIRT had a median PFS of 10 months, compared to 2 months in those treated with non-platinum-based regimens. Stratified analysis revealed that patients receiving platinum-based chemotherapy in the first-line setting achieved a median post-SIRT survival of 16 months, compared to 4 months for those treated in later lines. For non-platinum-based regimens, median post-SIRT survival was 9 months in the first-line and 6 months in later lines. Median OS from Stage IV diagnosis was 17 months for patients with liver-only metastases and 15 months for those with additional extra-hepatic disease, suggesting that liver disease burden remains a dominant driver of outcomes.

Conclusions

These findings describe survival outcomes among patients treated with SIRT and chemotherapy for metastatic PDAC in a real-world setting. Longer observed survival was seen in patients who received platinum-based chemotherapy alongside SIRT, particularly in the first-line setting. Given the descriptive design and small sample size, these findings should be interpreted as hypothesis-generating and may inform future prospective evaluation of SIRT–chemotherapy combinations.