Johns Hopkins Achieves 5% Pancreatic Cancer Recurrence Rate with Intraoperative Radiation Targeting "Baltimore Triangle"
Key Insights
Researchers at Johns Hopkins Kimmel Cancer Center (search) achieved a 5% recurrence rate in borderline resectable or locally advanced pancreatic cancer (search) patients using intraoperative radiation, believed to be the lowest ever reported for this population.
The breakthrough involves targeting the "Baltimore triangle (search)," a fatty, nerve-dense triangular area above the pancreas (search) where cancer cells commonly spread, using radioactive beads delivered during surgery.
Only one of 20 patients experienced recurrence at 24 months, compared to historical rates of 47% before targeted radiation approaches were implemented.
Researchers at the Johns Hopkins Kimmel Cancer Center (search) have achieved what they believe is the lowest recurrence rate after surgery ever reported for patients with borderline resectable or locally advanced pancreatic cancer (search). In a preliminary study presented at the American Society for Radiation Oncology (search) Annual Meeting in September 2025, investigators reported a 5% recurrence rate using intraoperative radiation therapy targeting a specific anatomical region they termed the "Baltimore triangle (search)."
Revolutionary Approach to Pancreatic Cancer Recurrence
The study enrolled 20 patients with borderline resectable or locally advanced pancreatic cancer (search) who received a comprehensive treatment approach combining presurgical chemotherapy, targeted radiation, and intraoperative radiation during tumor removal surgery. Only one patient experienced recurrence around the pancreas (search) at the 24-month mark, representing a dramatic improvement over historical outcomes.
"The combination of intraoperative radiation and targeting the Baltimore triangle (search) has gotten us to a 5% recurrence rate, which is the lowest-ever reported recurrence rate around the pancreas (search) for this population of patients to our knowledge. But I think we can drop to 0% in our next study," said Amol Narang, associate professor of radiation oncology and molecular radiation sciences at Johns Hopkins, who led the research team.
Identifying the Baltimore Triangle
The breakthrough came from Narang's team's discovery that pancreatic cancer (search) cells were spreading along nerves near the pancreas (search) to a fatty, nerve-dense triangular area just above the pancreas, which they named the "Baltimore triangle (search)." This anatomical region had been a common site of cancer recurrence that previous treatments failed to adequately address.
When the team initially started targeting the Baltimore triangle (search) with radiation before surgery to eliminate stray cancer cells, pancreatic cancer (search) recurrence rates dropped from 47% to 12% at two years post-surgery. However, in the 12% of patients who still experienced recurrences around the pancreas (search), the recurrences continued to occur specifically within the Baltimore triangle.
Intraoperative Radiation Technique
To further reduce recurrence rates, the researchers implemented an additional round of Baltimore triangle (search)-targeted radiation during surgery after removal of the pancreatic tumor. The technique uses a robotic device that carries small radioactive beads inserted through catheters, similar to brachytherapy, to deliver radiation directly to the targeted area.
The surgical approach provides a unique opportunity for precise radiation delivery. During the procedure, surgeons remove part of the small intestine next to the pancreas (search) called the duodenum (search), making it easier to access the Baltimore triangle (search) without risking harm to surrounding organs. This allows the team to deliver ablative doses of radiation to the region with unprecedented precision.
Clinical Significance and Future Directions
The results represent a major achievement for a cancer that has historically lagged behind other cancers in treatment success. By the time most pancreatic cancers are diagnosed, tumors have typically spread to affect important blood vessels around the pancreas (search), making surgical removal challenging or impossible.
"We must do whatever we can to prevent recurrences from happening, because when pancreatic cancer (search) comes back, it is often incurable. These results give us hope, though, that this can be done for a cancer where even a decade ago, most thought this wasn't possible," Narang commented.
The single recurrence in the study occurred in the part of the Baltimore triangle (search) that the team had difficulty reaching during the intraoperative treatment. The researchers are currently developing strategies to target this hard-to-reach area of the triangle, with hopes of reducing recurrences to zero.
Once they have refined their approach, the team plans to collaborate with other cancer centers across the country to conduct a larger clinical trial to validate their results and potentially establish this technique as a new standard of care for patients with borderline resectable or locally advanced pancreatic cancer (search).