Adding radiotherapy to neoadjuvant chemotherapy for resectable pancreatic ductal adenocarcinoma improved pathologic response rates but failed to enhance overall or event-free survival.

• Radiotherapy increased rates of pathologic complete response (6.6% vs. 4.4%) and R0 resections (85% vs. 52.2%).
• However, similar recurrence patterns were observed, with no significant difference in overall survival (HR 1.02) or event-free survival (HR 1.10).

Surgeons should note that despite improved pathological outcomes, the lack of survival benefit raises questions about the utility of routine radiotherapy in this context.