Supportive / QoL
2026-05-30 ASCO Annual Meeting 2026
SPIN Score (Celiac Plexus Radiosurgery) NCT03323489
ForPancreatic cancer with retroperitoneal pain considered for celiac plexus SRS
TL;DRPost-hoc predictors of pain response after celiac SRS: response 32% / 53% / 89% by 0 / 1 / 2 SPIN points.
The actionable RT read is timing, not technique: neurotoxic chemo exposure carried OR 5.1 (p=0.009) against response, so the referral decision moves earlier in the disease course, before oxaliplatin or taxane neuropathy. Celiac SRS is NCCN-listed and single-fraction, so the gate is who you irradiate and when, not dose.
In pancreatic cancer pts with retroperitoneal pain scoring above 6 and no prior neurotoxic chemo, this supports considering celiac SRS earlier rather than after systemic lines; it does not tell you what to do for the chemo-exposed, low-pain pt, where response was 32%.
The gate on celiac SRS is patient selection and timing, not plan quality: neurotoxic chemo exposure carried OR 5.1 (p=0.009) against pain response, and 2-point pts responded 89% vs 32% at 0 points. Argues for taking the referral early rather than as last-line salvage.
The variable that mattered is one med onc controls: prior neurotoxic chemotherapy predicted failure of celiac SRS (OR 5.1, p=0.009). For a pt with severe retroperitoneal pain, this argues for a celiac SRS referral alongside, not after, an oxaliplatin or taxane backbone.
| SPIN score | n | Pain response |
|---|---|---|
| 0 | 31 | 32% |
| 1 | 40 | 53% |
| 2 | 19 | 89% |
10 details
Post-hoc analysis of the pivotal single-arm phase 2 celiac plexus radiosurgery trial (NCT03323489), n=90 evaluable. Candidate baseline predictors screened by univariate then multivariate logistic regression, with only multivariate-significant variables carried into the score. Internal validation by bootstrap resampling, 500 iterations, for an optimism-corrected AUC.
Pain response per parent protocol: a ≥2-point reduction in average pain on the Brief Pain Inventory-Short Form, baseline to three weeks. Parent-trial response was 53% (95% CI 42-64%).
Only neurotoxic chemotherapy exposure (OR 5.1, p=0.009) and baseline pain intensity (OR 1.8, p=0.003) survived multivariate analysis; age and therapy line dropped out to collinearity. The resulting 2-point score separated response into 32% / 53% / 89%, with AUC 0.716 apparent, 0.714 optimism-corrected.
| Predictor | Univariate | Multivariate |
|---|---|---|
| Neurotoxic chemo exposure | OR 5.33 (2.13-13.4), p<0.001 | OR 5.1, p=0.009 |
| Baseline pain intensity | OR 1.73, p=0.003 | OR 1.8, p=0.003 |
| Age | OR 1.06, p=0.014 | lost significance |
| Therapy line | OR 0.65, p=0.04 | lost significance |
The score was derived and internally validated in the same 90 pts, so the bootstrap corrects optimism from resampling but not from the variable-selection step that preceded it. The 2-point stratum is n=19, and the dichotomy at pain >6 was picked from the same data that shows steeper response above 7 and 8.
The neurotoxic-chemo term is the interesting one because it is a timing variable a clinician controls, not a fixed patient trait: it implies referral for celiac SRS competes with the systemic sequence rather than following it. Whether that reflects true nerve injury blunting an ablative pain response, or confounding by later-line disease biology, the post-hoc design cannot separate.
Post-hoc derivation on the parent trial's own 90 pts; internal bootstrap only, no external cohort. Design dominates the read regardless of effect size.
- External validation of the SPIN score in an independent cohort
- Is neurotoxic chemo effect causal or a proxy for later-line disease
- Durability of pain response beyond the 3-week endpoint
📚 Sources · 🐦 1 tweet
Celiac SRS = convenient, effective tx for intractable pain, but who benefits most?
— Dr. Nina Niu Sanford (@NiuSanford) May 30, 2026
Post-hoc Ph2 analysis identified 2 response predictors (SPIN score): severe baseline pain & no prior neurotoxic chemo.
Supports earlier use before potential chemo neuropathy. #ASCO26 @OncoAlert pic.twitter.com/3qFYU6N1iD