Surgery or radiation after chemotherapy for advanced stomach and pancreatic cancers

This trial is testing whether people with advanced cancers of the digestive system (including esophagus, stomach, pancreas, and bile ducts) benefit from surgery or radiation therapy added to standard chemotherapy. The study focuses on patients whose cancer has spread to only a few locations and whose cancer markers (called circulating tumor DNA) have become undetectable after initial chemotherapy—suggesting the cancer is responding well. The trial will compare two groups: one continuing standard chemotherapy alone, and another receiving additional surgery or radiation to remove or treat remaining cancer sites.

Some patients with limited spread of these aggressive cancers may benefit from surgery or radiation to treat remaining tumors, but it's not yet clear which patients benefit most or whether this approach improves long-term survival. This trial will help doctors understand whether adding these interventions to chemotherapy extends how long patients stay cancer-free.