Guideline Video
Guideline Resources
- Radiation Therapy For Pancreatic Cancer
- American Society for Radiation Oncology
- August 11, 2026
- Summary
- Full-text
Video Transcription
Just published August 11th, 2026, the American Society for Radiation Oncology’s newest guideline on Radiation Therapy For Pancreatic Cancer.
The purpose of this guideline is to provide evidence-based recommendations on the use of radiation therapy (RT) for the treatment of pancreatic cancer in a variety of clinical settings including patients with resectable, borderline resectable, locally advanced, metastatic, and symptomatic disease.
In today’s rapid update, we’ll just be going over a summary of recommendations so for the full guideline, make sure to check it out on guidelinecentral.com
Let’s get started.
Starting with the section on Indications for RT and sequencing with systemic therapy and resection
- For patients with resectable pancreatic cancer receiving preoperative therapy, preoperative chemoradiation is conditionally recommended.
- For patients with resectable pancreatic cancer and pathologically uninvolved lymph nodes who did not receive preoperative chemoradiation or RT, postoperative chemoradiation after multiagent chemotherapy is conditionally recommended.
- For patients with borderline resectable pancreatic cancer, preoperative chemoradiation or RT is recommended.
- For patients with locally advanced pancreatic cancer, chemoradiation or RT after multiagent chemotherapy is recommended.
- For patients with medically inoperable pancreatic cancer or who are fit and decline surgery, chemoradiation or RT following multiagent chemotherapy is recommended.
- For patients with nonmetastatic pancreatic cancer receiving preoperative chemoradiation or RT, surgery is recommended to occur 4-8 weeks after RT.
- For patients with nonmetastatic pancreatic cancer receiving chemoradiation, concurrent single-agent chemotherapy is recommended.
Next the section on Appropriate dose-fractionation regimens and target volumes
- For patients with resectable pancreatic cancer receiving preoperative chemoradiation, moderate hypofractionation is conditionally recommended.
- For patients with resectable pancreatic cancer receiving postoperative chemoradiation, conventional fractionation is recommended.
- For patients with borderline resectable pancreatic cancer receiving preoperative chemoradiation, the following options are recommended:
- Conventional fractionation: 5000-5400 cGy in 25-30 fractions
- Moderate hypofractionation: 3600 cGy in 15 fractions
- For patients with borderline resectable pancreatic cancer receiving preoperative RT, stereotactic body radiation therapy (SBRT) is conditionally recommended.
- For patients with locally advanced pancreatic cancer receiving chemoradiation or RT without dose escalation, the following options are recommended:
- Conventional fractionation: 5000-5400 cGy in 25-30 fractions
- SBRT: 3300-4000 cGy in 5 fractions
- For patients with locally advanced pancreatic cancer receiving chemoradiation or RT with dose escalation, the following options are recommended:
- Moderate hypofractionation: 6750 cGy in 15 fractions or 7500 cGy in 25 fractions
- SBRT: >4000-5000 cGy in 5 fractions
- For patients with nonmetastatic pancreatic cancer receiving RT with preoperative or definitive intent, elective targeting of high-risk sites for microscopic disease is recommended.
- For patients with nonmetastatic pancreatic cancer receiving RT, the following options are recommended for elective target volume dosing:
- Conventional fractionation: 4500-5040 cGy in 25-28 fractions
- Moderate hypofractionation: 3600-3750 cGy in 15 fractions or 4500-5000 cGy in 25 fractions
- SBRT: 2500-3300 cGy in 5 fractions
Then the section on Preferred treatment planning and delivery techniques
- For patients with nonmetastatic pancreatic cancer receiving chemoradiation or RT, intensity modulated radiation therapy is recommended over 3-D conformal radiation therapy.
- For patients with nonmetastatic pancreatic cancer receiving chemoradiation or RT, a patient-specific respiratory motion assessment is recommended.
- For patients with nonmetastatic pancreatic cancer receiving chemoradiation or RT, respiratory motion management is conditionally recommended.
- For patients with nonmetastatic pancreatic cancer receiving chemoradiation or RT, fasting for at least 2 hours before simulation and treatment is recommended.
- For patients with nonmetastatic pancreatic cancer treated with chemoradiation or RT, IV contrast at simulation is recommended, unless there is a contraindication to IV contrast.
- For patients with nonmetastatic pancreatic cancer receiving dose-escalated moderately hypofractionated chemoradiation or SBRT, fiducial markers are conditionally recommended.
- For patients with nonmetastatic pancreatic cancer receiving chemoradiation or RT, daily image guidance is recommended.
- For patients with pancreatic cancer, adaptive RT is recommended for dose-escalated SBRT to maintain safe OAR doses and optimize target coverage.
And last the section on Indications for RT in the setting of recurrence, reirradiation, metastatic disease, and/or palliation
- For patients with pancreatic cancer and isolated locoregional recurrence after surgery and no prior RT, definitive-intent chemoradiation or RT with or without induction and/or consolidation chemotherapy is recommended.
- For patients with pancreatic cancer and isolated locoregional recurrence after prior RT, reirradiation with or without induction and/or consolidation chemotherapy is conditionally recommended.
- For patients with oligometastatic pancreatic cancer, definitive-intent chemoradiation or RT is conditionally recommended to the metastatic lesions and primary tumor as part of a multidisciplinary discussion.
- For patients with oligoprogressive pancreatic cancer, definitive-intent chemoradiation or RT is conditionally recommended to the metastatic lesions and primary tumor as part of a multidisciplinary discussion.
- For patients with pancreatic cancer-related symptoms, RT for palliation is recommended.
And there you have it. Make sure to check out the full guideline from the American Society for Radiation Oncology and other related clinical decision support tools at guidelinecentral.com.
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