Understanding the challenge of inoperable pancreatic cancer
Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive solid tumors, with limited treatment options for patients whose disease is non-metastatic but inoperable. For these individuals, conventional treatment often focuses on systemic therapy and palliative care, aiming to control symptoms and extend survival without compromising quality of life. In this context, stereotactic body radiation therapy (SBRT) has emerged as a targeted, high-precision modality that delivers ablative doses to the tumor while sparing surrounding healthy tissue. The TORPEDO trial is a randomized phase II study designed to assess whether SBRT can improve outcomes for patients with inoperable, non-metastatic PDAC compared with standard care approaches.
What is the TORPEDO trial?
The TORPEDO study investigates the safety and efficacy of SBRT as a treatment option for PDAC patients who cannot undergo surgical resection. By using advanced imaging and delivery techniques, SBRT aims to deliver high-dose radiation to the pancreatic tumor over a small number of sessions, potentially achieving better local control with manageable toxicity. The trial’s randomized design enables a direct comparison against contemporary non-SBRT regimens, providing insights into whether this precise form of radiation can translate into meaningful clinical benefits for this patient group.
Why SBRT might change the standard of care
SBRT offers several potential advantages for inoperable, non-metastatic PDAC. First, its precision minimizes exposure to nearby organs such as the stomach, duodenum, and kidneys, which may reduce treatment-related side effects. Second, the condensed treatment schedule can be more convenient for patients, compared with prolonged conventional radiotherapy. Third, higher biologically effective doses may improve local tumor control, potentially delaying progression and alleviating symptoms such as pain or obstructive complications. The TORPEDO trial explores these hypotheses in a rigorous randomized framework, which is essential to determine real-world applicability and safety.
Trial design and endpoints
In this phase II study, eligible participants with non-metastatic, inoperable PDAC are randomized to receive SBRT in addition to standard care versus standard care alone. Primary endpoints typically include local control of the pancreatic tumor and progression-free survival, with secondary endpoints addressing overall survival, treatment-related toxicity, and patient-reported outcomes. The study also monitors quality of life, a critical consideration for patients facing a challenging diagnosis where symptom management is a central goal of care.
Interpreting potential outcomes
If TORPEDO demonstrates a clear benefit in local control and acceptable safety, SBRT could become a valuable option in multidisciplinary treatment planning for inoperable PDAC. Conversely, if no advantage or excessive toxicity is observed, results will help refine patient selection criteria and dosing strategies for future trials. Either outcome will advance our understanding of how best to balance aggressive local therapy with the overarching aim of maintaining quality of life in vulnerable patients.
Looking ahead
The TORPEDO trial exemplifies a broader shift toward precision radiotherapy in pancreatic cancer, a field evolving with adaptive planning, image guidance, and integration with chemotherapy and targeted agents. As results emerge, clinicians will weigh SBRT against other non-surgical options, tailoring treatment to tumor biology, patient preferences, and overall health status. The ultimate goal remains to extend meaningful survival while preserving function and comfort for people living with PDAC.
