Supportive / QoL
2026-05-30 ASCO Annual Meeting 2026
SPIN Score (Celiac Plexus SRS) NCT03323489
ForPancreatic cancer, intractable retroperitoneal pain, celiac SRS candidates
TL;DR89% pain response at SPIN 2 vs 32% at SPIN 0 for celiac SRS; post-hoc selection score, n=90.
Response is threshold-gated on baseline pain (>6 → 65.8%, rising to 85.7% at >8), and the strongest predictor was neurotoxic-chemo exposure (multivariate OR 5.1). The RT decision this moves is timing: refer for celiac SRS before neurotoxic agents. SRS dose/fractionation not reported in source (parent Lancet Oncol trial).
9 details
Post-hoc predictor analysis of the pivotal single-arm phase 2 celiac plexus SRS trial (NCT03323489, Lancet Oncol 2024). 90 evaluable pts; univariate/multivariate logistic regression with 500-iteration bootstrap internal validation.
Pancreatic-cancer pts with intractable retroperitoneal (celiac) cancer pain treated on the phase 2 SRS trial. Age and BMI were the prior-reported predictors; median baseline values not in source.
Celiac plexus radiosurgery, target D12-L2. Dose and fractionation not reported in source (specified in the parent Lancet Oncol trial), so transferability of the technique can't be judged here.
Pain response = ≥2-point reduction in average BPI-SF pain from baseline to 3 weeks. Score performance judged by optimism-corrected AUC.
Two independent predictors (severe baseline pain, no prior neurotoxic chemo) build a 0-2 score with a monotonic response gradient (see tables). Discrimination modest, AUC 0.714 corrected.
| SPIN score | Pain response | n |
|---|---|---|
| 0 | 32% | 31 |
| 1 | 53% | 40 |
| 2 | 89% | 19 |
| Predictor | Univariate OR | Multivariate OR |
|---|---|---|
| Neurotoxic chemo exposure | 5.33 (2.13-13.4), p<0.001 | 5.1, p=0.009 |
| Baseline pain intensity | 1.73, p=0.003 | 1.8, p=0.003 |
| Age | 1.06, p=0.014 | dropped (collinearity) |
| Therapy line | 0.65, p=0.04 | dropped (collinearity) |
Celiac plexus SRS is a novel non-invasive palliative option recently added to NCCN guidelines. This analysis converts the parent trial's flat response into an actionable selection score and argues for earlier use, before neurotoxic chemotherapy.
Post-hoc, single-arm data; predictors are associative. Internal bootstrap validation only (optimism-corrected AUC 0.714), external validation required. Subjective 3-week pain endpoint; score not prospectively tested.
Post-hoc predictor modeling of a single-arm phase 2; internal bootstrap validation only, external validation pending. Associations, not a prospectively validated selection tool.
In pancreatic-cancer pts with severe retroperitoneal pain and no prior neurotoxic chemo (SPIN 2), this supports earlier celiac plexus SRS, where 89% (n=19) achieved pain response; it does not extend to SPIN-0 pts, whose response was 32% (n=31).
- External validation of the SPIN score in an independent cohort
- Whether earlier SRS before neurotoxic chemo improves outcomes prospectively
- Durability of pain response beyond 3 weeks
📚 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