Intraoperative Radiation for Pancreatic Cancer

Pancreatic cancer (PDAC) remains a challenging disease to treat with a poor prognosis. Management of PDAC has evolved over the last several decades with the development of more effective systemic therapy making local control of the primary tumor paramount in patients with both resectable and unresectable disease. Local recurrence after resection or progression of an unresectable tumor are significant causes of morbidity and potential mortality for patients with PDAC. Emerging data in PDAC suggest that improved local control and favorable survival can be achieved with radiation dose escalation. However, adjacent radiosensitive organs limit the ability to deliver higher doses of radiation therapy to patients. Intraoperative radiation therapy provides an ideal way to deliver large doses of radiation directly to the tumor or tumor bed while minimizing the radiation dose to adjacent normal organs. The purpose of this review is to provide an overview of the current literature demonstrating the utility of intraoperative radiation therapy in patients with resectable and unresectable PDAC.