Aim of our study was to evaluate the feasibility and safety of the endoscopic ultrasound (EUS)-guided intratumoural injection of phosphorus-32 (³²P), an emerging local ablative technique that may enhance local disease control and surgical conversion when used alongside systemic therapy, in patients with pancreatic cancer.

This single-centre observational study assessed the feasibility and outcomes of EUS-guided fine-needle ³²P injection in patients with LAPC receiving gemcitabine–nab-paclitaxel at the University Hospital of Santiago de Compostela between September 2024 and September 2025.

Eleven patients were included (mean age 66.5 years; range 48–84). Tumour locations were the pancreatic head (n=6), neck (n=2), and body (n=3), all demonstrating vascular involvement. Mean tumour diameter was 30.6 mm (22–45) on CT and 34.6 mm (25–45) on EUS, with a mean volume of 9.17 cc (1.8–36.2). Mean ³²P dose was 48.6 MBq (1.5–223). No immediate complications were observed; 18% experienced mild adverse events, and one patient developed moderate acute pancreatitis. Chemotherapy was resumed in 91% after 9.8 days (mean interval). One patient (9%) underwent successful R0 resection. Local progression occurred in 9% and distant progression in 36%. Median CA 19-9 levels decreased from 695.8 U/mL (2.3–2458.7) at baseline to 185.6 U/mL (2.1–852.4) post-treatment. Median overall survival and progression-free survival were 291.5 and 273 days, respectively. 

EUS-guided ³²P injection appears to be a feasible and safe local ablative approach for patients with LAPC. It can be seamlessly integrated into treatment protocols without compromising subsequent surgical resection