An ASTRO multidisciplinary task force developed evidence-based recommendations on radiation therapy (RT) for pancreatic cancer across clinical settings: resectable, borderline resectable, locally advanced, metastatic, oligometastatic, and palliative disease, addressing indications, dose-fractionation, target volumes, and planning techniques.
Key recommendations include: RT conditionally recommended pre- and postoperatively for resectable disease; RT recommended preoperatively for borderline resectable and definitively for locally advanced disease; conventional fractionation or moderate hypofractionation for preoperative RT; conventional fractionation for postoperative RT; dose escalation via SBRT or moderate hypofractionation supported by emerging evidence in the definitive setting; adaptive RT recommended for dose-escalated SBRT; palliative RT recommended for bleeding, pain, and obstruction; RT conditionally recommended for oligometastatic/oligoprogressive disease.
Recommendations are guideline-based (systematic review + consensus methodology) rather than from a single trial, so strength of individual recommendations varies; emerging evidence for dose-escalated SBRT is noted as not yet definitive; guideline does not report original patient-level outcome data.
All pancreatic cancer patients should have multidisciplinary evaluation before RT decisions are made. For locally advanced disease, definitive RT is recommended, with adaptive RT required when using dose-escalated SBRT; palliative RT should be offered for bleeding, pain, or obstruction regardless of disease stage.
Explore related topics
