A Phase 3 interventional study of Pancreatic surgery and MRI guided stereotactic ablative radiotherapy in Locally Advanced Pancreatic Carcinoma (LAPC), sponsored by Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA). Not yet recruiting. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-10-09.
Sponsored by Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA) · Phase 3, Interventional, and Treatment
The primary objective of this study is to assess the added value of surgical exploration with intention for resection compared to MRI guided stereotactic ablative radiotherapy (SABR) in improving overall survival in patients with locally advanced pancreatic carcinoma (LAPC) who show a favourable biological response to systemic induction chemotherapy.
The current evidence on the added survival benefit of surgery after induction chemotherapy is limited by strong selection bias, and international guidelines state that the longterm survival benefit of surgery in locally advanced pancreatic carcinoma (LAPC) remains uncertain. In parallel, stereotactic ablative radiotherapy (SABR), particulary MRI guided SABR, had emerged as a promising less invasive alternaitve, achieving high local control rates with limited toxicity. Therefore, this international, multicentre, open-label, phase 3 superiority randomized clinical trial assesses whethersurgery improves overall survival as compared to MRI-guided SABR. Primary objective is overall survival, secondary objectives include evaluation of failure free survival, quality of life, and serious adverse events.
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA) is the lead sponsor of 532 studies on the registry; 185 are open to participants now.
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Patients diagnosed with pathology proven (WHO 6-7) LAPC according to the 2025 NCCN guideline. Of note, WHO-3 is allowed for inclusion in case of evidence for neoplasia by molecular analyses if cystic lesions are absent. Chemotherapy may be started without pathologyproof after a least two attempts via fine-needle biopsy if the patient has a high radiological and clinical suspicion for pancreatic adenocarcinoma and consensus has been reached in the responsible multidisciplinary conference. Furthermore, patients must meet the following established A-B-C parameters after at least three months systemic induction therapy:
NB. If a systemic treatment switch is performed in the setting of induction therapy with the indication of (biochemical) disease progression, restaging according to the above-mentioned criteria are performed with using the A-B-C features between the first- and second-line systemic induction therapy as baseline.
* Patients who require a resection of the superior mesenteric artery (SMA) are only allowed for inclusion by centres where this is routine practice, as evidenced by a volume of on average ≥15 SMA resections for periampullary cancer over the preceding three years, considering the high risks of complication-related mortality. This also means that patients with an SMA string sign (i.e. irregularity of the arterial wall) on cross-sectional imaging after systemic induction therapycannot be randomized at centers. At baseline, serum CA19-9 is measured with a total bilirubin as low as possible and measured as short as possible before the start of chemotherapy. At restaging, serum CA19-9 is ideally measured in the same lab due to different essays with widely diverging results.
#Preferably, FDG-PET scan is performed with EARL reconstruction protocol 1 or 2.
- Informed consent: Competent and willing to provide informed consent in accordance with the requirements of the ethics committee.
Exclusion Criteria:
- Prior treatment: Prior systemic induction therapy combined with any type of radiother-apy. Radiotherapy is not used as induction therapy as it has not been proven beneficial and considering the potential increased risk of major morbidity, although particularly seen with external beam radiotherapy. The only other possible indication for radio-therapy that is allowed in this trial is a single fraction of 8 Gray in case of tumour bleed-ing.
- Metastatic disease: Presence of metastatic disease
- Comorbidities: Clinical deterioration during systemic induction therapy or increase of suspected tumour-related pain after excluding other potential causes of pain (e.g., pancreatitis, stent dysfunction).
- History of other malignancies: A past medical history of malignancy, except under the following conditions: no evidence of disease, diagnosis more than three years ago before the diagnosis of pancreatic cancer, and life expectancy of more than five years from date of inclusion. Of note, a past medical history of non-melanoma skin cancer, pancreatic neuroendocrine tumour \<2 cm, and gastrointestinal stroma tumour (GIST), or any other cancer with a life expectancy beyond five years are no exclusion criteria. Lastly, lesions on CT thorax that are too small to characterize are not considered met-astatic disease. The last exclusion criterium is tumours directly invading gastrointestinal hollow organs, except the duodenum.
Pancreatic surgery
Procedure: Pancreatic surgery
MRI guided stereotactic ablative radiotherapy
Radiation: MRI guided stereotactic ablative radiotherapy
Surgical exploration starts with a staging laparoscopy, unless already performed previsouly. Hereafter, exploration is typically performed via laparotomy. Although heterogeneity exist in surgical techniques, the following general surgical principles are considered state-of-the-art: 1. Artery-first approach in case of potential arterial involvement 2. Arterial divestment in case of radiological signs of (former) involvement without current signs of arterial wall ingrowth (and negative biopsy of peri-arterial tissue) during surgery to remove all (former) tumour tissue. 3. In case of vascular reconstruction that requires a patch or interposition graft, an autol-ogous (e.g., veins, peritoneal / falciform patch, splenic artery) or biological (e.g., bovine patch) graft is strongly preferred over synthetic prosthesis
MRI-guided SABR must be initiated within four weeks after randomization and is delivered in a hypofractioned regimen of 50 Gy in five fractions of 10 Gy, prescribed to 95% of the planning target volume (PTV). Treatment will be administered on alternative days, two or three times per week, with an intended overall treatment duration of two weeks (i.e., 14 days). All patients will undergo an MR (and CT scan at the department's discretion) for radiotherapy planning. The gross tumour volume (GTV) will be defined based on those imaging datasets and the restaging imaging. A PTV margin of 3mm is applied. Two MRI-guided SABR platforms are allowed. 1.5 Tesla MR-Linac and MRIdian system (0.35 Tesla MR-Linac). All patients will receive a proton pump inhibitor (oral) once daily during MRI-guided SABR, continued for three months afterwards to reduce gastrointestinal toxicity.
Overall survival
This will be measured in days. Participants receive systemic induction therapy before randomization, with a minimum duration of 3 months but no fixed duration. Therefore, overall survival is measured from the date of randomization.
Time frame: Measured from the date of randomization to the date of documented death by any cause or the date of last follow up, whichever occurs first, assessed up to at 5 years of randomization.
Failure free survival
To compare the failure free survival (FFS) between surgical exploration with intention for resection and MRI guided stereotactic ablative radiotherapy. Failure is defined as any of the following: local relapse/recurrence, local progression, regional relapse/recurrence, regional progression, development of distant metastases, or occurrence of a second primary pancreatic cancer.
Time frame: FFS is measured in days from date of randomization to date of first documented failure (whichever occurs first). Participants without documented failure will be censored at the date of last follow-up. FFS will be assessed up to 5yrs after randomization
Quality of life
functioning, and symptoms scores and the summary score during the first two years from randomization, using the EORTC QLQ-C30 (version 3.0). The higher the score, means more complaints. Scale 1-4. 30 questions.
Time frame: First two years from randomization
serious adverse events
defined following the NCI Common Terminology Criteria for Adverse Events (CTCAE) (version 5.0) (grade ≥III),71 expressed as the number of patients with serious adverse event(s), the number of events, and type of events.
Time frame: Six-months serious adverse events (SAEs) that occur from randomization
Global quality of life
Functioning, and symptoms scores and the summary score during the first two years from randomization using the EORTC PAN26 questionnaires. The higher the score, the more complaints. Scale 1-4. 25 questions.
Time frame: First two years from randomization
in hospital/90 day major morbidity
defined as Clavien-Dindo classification grade ≥IIIa
Time frame: Measured from intervention until 90 days after intervention or discharge.
in hospital/90 day clinically relevant pancreatic surgery specific complications
including post pancreatectomy hemorrhage, postoperatove pancreatic fistula, post pancreatectomy acute pancreatitis, delayed gastric emptying, chyle leak, and bile leak (grade B/C)
Time frame: Measured from surgery until 90 days after intervention or discharge.
R0 resection rate
R0 resection status will be determined based on the final histopathological examination of the pancreatic resection specimen. Defined according to the 1mm rule following th royal collega of pathologists and international collaboration on cancer reporting, except for the anterior surface where a 0mm rule will be applied, and strtified for surgical and pathological margins in accordance with the 2025 ISGPS-ISGPP statement
Time frame: Resection rate should be assessed by a pathologists within 2 weeks from pancreatic surgery
Overall survival
This will be measured in days.
Time frame: From the date of imaging-based diagnosis until death from any cause or the end of follow-up, assessed up to 5 years after randomization
No study locations are listed for this record.
Documents are hosted by the registry — open the source record to download them.
Plan to share: No — Data sharing between the participating parties will be covered in the Consortium Agreement. Data will be handled confidentially and coded. The handling of personal data will comply with the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data (General Data Protection Regulation). A subject identification code list will be used to link the data to the subject. These codes will not be based on the patient initials and birth date. The coordinating investigator will safeguard the key to this code. The data will be kept for 15 years.
Start is estimated for Oct 2026; primary completion for Oct 2034, 96 months later.
How these figures are worked out, and which studies are left out of them.
From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
This study is not yet recruiting, as verified in Oct 2026. You cannot join it, but the record below documents what was studied.
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