The SPIN Score for Pancreatic Cancer Pain: Who Benefits More from Radiosurgery?
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The SPIN Score for Pancreatic Cancer Pain: Who Responds Better to Celiac Plexus Radiosurgery?
What was the study?
The analysis is based on a post-hoc evaluation of 90 patients in the phase 2 study assessing celiac plexus radiosurgery. Pain response was defined as a decrease in the Brief Pain Inventory-Short Form average pain score from baseline to week 3 of at least 2 points .
The researchers examined baseline clinical variables and aimed to develop a selection score that could be used in practice without being excessively complex. In the multivariable analysis, two factors remained independently significant: no previous neurotoxic chemotherapy and high baseline pain.
It is the delivery of high-dose, focused radiotherapy to the celiac plexus region, which plays an important role in transmitting pain around the pancreas. The aim is to provide palliative relief by reducing pain transmission rather than shrinking the tumor.
How is the SPIN score calculated?
| SPIN component | Points | Clinical significance |
|---|---|---|
| Severe baseline pain | +1 | The patient receives 1 point if the baseline average pain score is >6. |
| Intact nerves / no neurotoxic chemotherapy | +1 | The patient receives 1 point if there has been no previous exposure to neurotoxic chemotherapy. |
| Total score | 0–2 | The probability of a pain response increases significantly as the score rises. |
Oxaliplatin, paclitaxel, nab-paclitaxel, and similar neurotoxic agents may contribute to peripheral nerve injury. The poster data suggest that patients not exposed to these agents may have a higher pain response to celiac plexus radiosurgery.
Main results
| Outcome | Data | Clinical interpretation |
|---|---|---|
| SPIN 0 response rate | %32; n=31 | The group with a low probability of response. |
| SPIN 1 response rate | %53; n=40 | Intermediate probability of response. |
| SPIN 2 response rate | %89; n=19 | The group with a very high probability of response. |
| Model performance | AUC 0,716; after bootstrapping 0,714 | Reasonable discrimination for a simple model with two variables. |
Clinical significance
Rather than treatment efficacy, this study seeks to understand which patients can be expected to have a higher pain response . The most important message is this: the probability of response may be higher if celiac plexus radiosurgery is considered before exposure to neurotoxic chemotherapy occurs and when pain becomes more pronounced.
This approach is particularly important in pancreatic cancer, because pain is not merely a symptom but a major clinical problem that directly affects quality of life, nutrition, sleep patterns, opioid requirements, and treatment tolerance.
Points to consider
The SPIN score was developed from a post-hoc analysis; it is therefore not a prospectively planned decision tool validated in an external cohort. It must be validated in independent patient groups before entering clinical practice. At present, this score should not determine treatment selection on its own and should be viewed as a hypothesis-generating tool supporting patient–physician decisions.
Drozdogan Academic Commentary
The SPIN score is very practical ASCO 2026 evidence supporting the idea of positioning palliative treatment earlier and more intelligently for pancreatic cancer pain.
The fact that the score distinguishes response rates ranging from %32 to %89 using only two variables suggests that celiac plexus radiosurgery could be used much more effectively through patient selection.
The most important message is this: we should view palliative interventions not only as a last resort but as targeted interventions timed correctly in relation to the biology of pain and before nerve damage develops.
Conclusion
The SPIN score analysis presented at ASCO 2026 proposes distinguishing patients who may respond to celiac plexus radiosurgery for pancreatic cancer-related retroperitoneal pain using two simple clinical variables: high baseline pain and no previous neurotoxic chemotherapy. In patients with a score of 2, the pain response reaches %89.
These data may be an important step toward earlier, more selective, and more patient-centered palliative radiosurgery strategies in pancreatic cancer pain management. However, external validation is essential before the SPIN score enters clinical practice.
- ASCO 2026 Poster. The SPIN Score, a simple clinical score to predict pain response following celiac plexus radiosurgery for retroperitoneal cancer pain in pancreatic cancer. Abstract #546246, Board #194.
- Lawrence YR et al. Celiac plexus radiosurgery for pain management in advanced cancer: a multicentre, single-arm, phase 2 trial. Lancet Oncology. 2024.
- The ASCO Post. Pancreatic Cancer: Celiac Plexus Radiosurgery for Retroperitoneal Pain Syndrome. 2024.
- ClinicalTrials.gov. Celiac Plexus Radio-Surgery for Pain Management. NCT03323489.
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