The radiation modalities currently recommended in the National Comprehensive Cancer Network (NCCN) Guidelines are photon-based, and protons are not considered standard of care. Twelve- and 24-month cumulative incidence of locoregional failure were 17.6% and 32.8% respectively. Respective 12- and 24-month overall survival were 74% and 38%.
Our group has shown that ablative radiation therapy following multiagent induction therapy for locally advanced pancreatic cancer was associated with durable locoregional control and favorable survival.
As for unresectable tumors, data are still limited, but radiation may play a role in delaying progression of locally advanced disease or in relieving symptoms of pain, bleeding, or local obstruction. After surgical resection, the standard of care is to offer adjuvant chemotherapy, with conflicting evidence on the role of adjuvant radiation therapy. The long-term results of the Dutch randomized PREOPANC trial, published recently in 2022, showed a significant improvement in overall survival (OS) with neoadjuvant CRT compared to upfront surgery (5-year OS rate: 20.5% vs. In case of resectable or borderline resectable tumors, offering neoadjuvant chemoradiotherapy (CRT) is suggested. The management of pancreatic cancer largely depends on its resectability.
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