Radiotherapy of pancreatic cancers: 2025 update

We present the updated recommendations of the French Society of Radiotherapy Oncology (Société française de radiothérapie oncologique, SFRO) on radiotherapy for pancreatic cancer. The place of radiation therapy in the treatment of patients with resectable or locally advanced pancreatic cancer is still controversial. In the postoperative setting, the standard treatment is adjuvant chemotherapy with 5-fluorouracil, irinotecan and oxaliplatin ("folfirinox" regimen) for 6 months. Adjuvant chemoradiotherapy may be beneficial for patients with N0 cancer. After induction chemotherapy, neoadjuvant chemoradiotherapy is used for borderline tumours in order to increase the chances of complete resection (R0) even if its benefit on patient survival has not been demonstrated. For locally advanced tumours, induction chemotherapy followed in non-progressive patients by chemoradiotherapy increases local control and the chances of resectability. Intensity-modulated radiotherapy reduces the doses received by organs at risk. Tumour movements related to breathing must be taken into account. Stereotaxic radiotherapy increases the dose received by the tumour while protecting neighbouring healthy organs.