ASTRO updates guideline on radiation therapy for pancreatic cancer

The American Society for Radiation Oncology (ASTRO) recently published an updated clinical guideline for the use of radiation therapy in treating adult patients with pancreatic cancer. This new guideline builds on the 2019 recommendations and incorporates findings from recent clinical trials that support the use of radiation therapy in resectable, locally advanced, and metastatic cases.

Pancreatic cancer remains one of the deadliest cancers, with epidemiologic models projecting it to become the second-leading cause of cancer-related death in the United States by 2030. Only around 20% of patients are surgical candidates at diagnosis due to the advanced or metastatic nature of many tumors. Most patients are treated with chemotherapy, and emerging therapies that target the RAS pathway may offer additional options for those with metastatic disease.

Radiation therapy plays a crucial role in multidisciplinary care, enhancing local control, aiding in surgery candidacy, and alleviating symptoms like pain or bleeding. As new systemic treatments extend patients' lives, the role of radiation therapy in controlling persistent or progressing disease at individual sites becomes increasingly significant.

The updated guideline provides clearer indications for radiation therapy use and highlights technological advancements like image guidance, motion management, and adaptive radiation therapy for more precise treatment. Key recommendations include multidisciplinary evaluation and decision-making for all patients before and during treatment.

The guideline also identifies important research areas, such as integrating radiation therapy with evolving systemic treatments to determine the most effective combinations and identifying the patients most likely to benefit from intensive local treatment.