Abstract
Surgery remains the most important modality in the treatment of resectable pancreatic cancer, but only 10-15% of patients are suitable candidates. Despite the still high rate of local recurrence after radical surgery, adjuvant radiotherapy has now been replaced by chemotherapy, which has been shown to have better outcomes in randomized trials.
Systemic therapy is also preferred in the neoadjuvant indication, but further studies investigating the position of radiotherapy in this group of patients are needed. Radiotherapy has a place in unresectable disease, where in combination with systemic therapy it affects local disease control and overall survival.
New radiotherapy techniques including hypofractionated ablative and stereotactic radiotherapy are preferred. In metastatic disease, radiation to metastases may also be considered with palliative intent or to delay disease progression and improve survival.
The use of new technologies for imaging and radiotherapy planning continues to evolve, but the combination of radiotherapy with more effective systemic therapy is also being used more.