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Radiation Therapy for Pancreatic Cancer: An ASTRO Clinical Practice Guideline
Michael D Chuong1, Krishan R Jethwa2, Ethan Ludmir3
1Department of Radiation Oncology, Baptist Health Herbert Wertheim Cancer Institute, Miami, Florida.
Practical Radiation Oncology
|August 11, 2026
Summary
This guideline offers evidence-based radiation therapy (RT) recommendations for pancreatic cancer across various stages. It details optimal RT use for resectable, locally advanced, and metastatic disease, aiming to improve patient outcomes.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Physics
Background:
- Pancreatic cancer presents complex treatment challenges across resectable, borderline resectable, locally advanced, metastatic, and symptomatic disease stages.
- Optimal utilization of radiation therapy (RT) requires clear, evidence-based guidelines tailored to diverse clinical scenarios.
Purpose of the Study:
- To establish evidence-based recommendations for the application of radiation therapy (RT) in the management of pancreatic cancer.
- To address key questions regarding indications, timing, dose-fractionation, target volumes, and techniques for RT in various pancreatic cancer settings.
Main Methods:
- A multidisciplinary task force from the American Society for Radiation Oncology conducted a systematic literature review.
- Recommendations were developed using a predefined consensus-based methodology with grading of evidence quality and recommendation strength.
- Four key questions guided the review: RT indications/timing for nonmetastatic disease, dose/volumes, planning/delivery techniques, and RT for recurrent/metastatic/palliative settings.
Main Results:
- Multidisciplinary evaluation is recommended for all pancreatic cancer patients.
- Radiation therapy (RT) is conditionally recommended preoperatively and postoperatively for resectable disease, and preoperatively for borderline resectable disease.
- Definitive RT is recommended for locally advanced disease, with conventional fractionation or hypofractionation; dose escalation with stereotactic body radiation therapy (SBRT) is supported by emerging evidence. RT is also recommended for recurrent, metastatic, and palliative situations.
Conclusions:
- These recommendations provide a framework for optimizing radiation therapy (RT) in pancreatic cancer treatment.
- Further research is needed to refine RT indications, sequencing with other therapies, and its overall impact on patient outcomes.
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Assessment:
Assessment: