From the Guidelines
Radiotherapy is indicated in pancreatic cancer for locally advanced unresectable disease, as adjuvant therapy following surgical resection, and for palliative purposes. The most recent and highest quality study, although not directly from 2025, provides guidelines from 2017 1, which still form the basis of current practice.
Indications for Radiotherapy
- Locally advanced unresectable disease: Radiotherapy combined with chemotherapy is a primary treatment option, with the goal of improving local control and delaying the need for further treatment.
- Adjuvant therapy: Following surgical resection, radiotherapy is recommended for patients with positive margins or lymph node involvement to reduce the risk of local recurrence.
- Palliative purposes: Radiotherapy is used to manage symptoms such as pain and obstruction in patients with metastatic disease.
Treatment Approaches
- Chemoradiotherapy: Combining radiotherapy with chemotherapy, such as gemcitabine or FOLFIRINOX, is a standard approach for locally advanced unresectable disease.
- Stereotactic body radiotherapy (SBRT): Delivering high doses of radiation in a few fractions, SBRT is increasingly used for locally advanced disease and in elderly or frail patients.
- Palliative radiotherapy: Short courses of radiotherapy are effective in managing symptoms and improving quality of life in patients with metastatic disease.
Considerations
- Performance status: Patients with good performance status are more likely to benefit from aggressive treatments, including chemoradiotherapy.
- Systemic therapies: The integration of radiotherapy with systemic therapies has shown improved local control and quality of life outcomes in pancreatic cancer management.
- Tumor biology: A better understanding of tumor biology is guiding personalized treatment selection, including the use of radiotherapy.
From the Research
Indications of Radiotherapy in Pancreas Cancer
- The use of radiation therapy for patients with pancreatic cancer is subject to discussion 2
- Chemoradiation may improve the survival of patients with incompletely resected tumours (R1) 2
- Neoadjuvant chemoradiation is a promising treatment especially for patients with borderline resectable tumours 2
- For patients with locally advanced tumours, there is no standard treatment, but an induction chemotherapy followed by chemoradiation for non-progressive patients reduces the rate of local relapse 2
Role of Radiotherapy in Treatment of Pancreatic Cancer
- Radiation therapy has emerged as a central pillar in the combined oncological treatment of pancreatic cancer 3
- Advanced modern radiotherapeutic techniques in combination with individualized high-precision radiation concepts are new therapeutic approaches for pancreatic cancer in a multimodal setting with tolerable side effects 3
- The effects of radiotherapy were uncertain as only one low-quality trial was included in a study comparing chemotherapy and radiotherapy for advanced pancreatic cancer 4
Comparison of Chemotherapy and Chemoradiation Regimens
- A comparative survival analysis between patients with resected pancreatic cancer who received adjuvant treatment with either gemcitabine- or 5-fluorouracil-based chemotherapy and chemoradiation regimens showed that outcomes for patients who received chemoradiation with gemcitabine did not differ compared with chemoradiation with 5-fluorouracil 5
- Patients who received gemcitabine without radiation had increased hazards, especially for poorly differentiated tumours 5
Recent Studies on Radiotherapy for Pancreatic Cancer
- A phase I trial studied the use of MR-guided radiation therapy with concurrent gemcitabine/nab-paclitaxel chemotherapy in inoperable pancreatic cancer, and found that full-dose gemcitabine/nab-paclitaxel with ablative magnetic resonance guided radiation therapy dosing is safe in patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma 6
- The trial also found that the treatment had promising local progression-free survival and distant metastasis-free survival rates 6