Abstract Treatment approaches for pancreatic cancer include surgery, systemic therapy, and radiation therapy, with the role of radiation determined primarily by resectability status. As modern systemic therapy has improved distant disease control, achieving durable local control has become increasingly important. In borderline-resectable disease, preoperative chemoradiotherapy has been shown to improve margin-negative (R0) resection rates, locoregional control, and disease-free survival. In resectable tumors, adjuvant chemoradiation has been beneficial in select patients. In locally advanced settings, conventional chemoradiation after induction chemotherapy has improved both local control and margin-negative (R0) resections. Additionally, modern dose-escalation strategies, including magnetic resonance guided (MR-guided) SBRT, have also improved local control while maintaining a favorable toxicity profile. Considering the expanding role of radiation, this review aims to summarize the application of radiation therapy across resectable, borderline resectable, locally advanced, and oligometastatic pancreatic cancer.
Gokhale et al. (2026) studied this question.