#ESMO26 Day 1 highlight for me: MASTERPLAN, now in Lancet Oncology.

Radiation and pancreatic cancer have a complicated history. ESPAC-1 suggested adjuvant chemoradiation hurt. LAP07 and CONKO-007 couldn't show an OS benefit after chemo. A021501 closed its RT arm for futility. PREOPANC-2 was a draw. We walked through the adjuvant side of this story in Sem Rad Onc last year: https://doi.org/10.1016/j.semradonc.2025.07.009

So why is MASTERPLAN different?
Phase 2, 14 sites in Australia and NZ (can i just say I love the Aus-NZ studies). 74 patients with high-risk localized PDAC, randomized 2:1 to chemo ± SBRT 40 Gy/5 after induction.

12-mo locoregional recurrence 20.2% vs 52.0%, sHR 0.44, p=0.022

PFS 11.9 vs 6.3 mo, HR 0.44

OS 22.0 vs 14.0 mo, HR 0.45

Grade ≥3 AEs 70% vs 64%.

Why did this one work when others didn't? The rad oncs can explain the physics better than I can. I just read it as better tumor zap zap.

Does it change practice? Maybe. I think we need to have a deeper conversation at every tumor board, but the juice seems worth the squeeze.
@OncoAlert @TheGutOncLab @Onco_Nexus
https://www.sciencedirect.com/science/article/pii/S1470204526005322