Despite ongoing efforts, patients with locally advanced pancreatic cancer (LAPC) continue to have a dismal prognosis. Such tumors are unresectable, and optimal treatment with chemotherapy and/or radiation therapy is still not established. While chemotherapy is conventionally aimed at preventing metastatic spread of disease, radiation therapy acts locally, improving local control which can potentially improve overall survival and most importantly quality of life. Here, we aim to review the primary literature assessing the role of diverse radiation therapy strategies for patients with LAPC.

Many radiation regimens can be considered, and no standard treatment has demonstrated a clear improvement in clinical outcomes. We advise that the modality of choice be dependent on the availability of equipment, the dose and fractionation of treatment, as well as the dose received by normal tissue. Moreover, a candid discussion with the patient concerning treatment goals is equally as essential. Three notable strategies for LAPC are intensity-modulated radiation therapy, volumetric modulated arc therapy, and proton. These radiation modalities tend to have improved dose distribution to the target volumes, while minimizing the radiation dose to surrounding normal tissues. Stereotactic body radiation therapy can also be considered in LAPC patients in cases where the tumor does not invade the duodenum or other neighboring structures. Because of the high doses delivered by stereotactic body radiation therapy, proper respiratory and tumor motion management should be implemented to reduce collateral radiation dosing. Despite improved clinical outcomes with modern radiation modalities, evolving techniques, and more accurate planning, future studies remain essential to elucidate the optimal role for radiation therapy among patients with LAPC.

尽管不断努力，局部晚期胰腺癌 (LAPC) 患者的预后仍然不佳。此类肿瘤不可切除，化疗和/或放疗的最佳治疗仍未确定。虽然化学疗法通常旨在防止疾病的转移性传播，但放射疗法在局部起作用，改善局部控制，这可能会提高总体生存率，最重要的是提高生活质量。在这里，我们旨在回顾评估不同放射治疗策略对 LAPC 患者的作用的主要文献。

可以考虑许多放疗方案，但没有标准治疗表明临床结果有明显改善。我们建议选择的方式取决于设备的可用性、治疗的剂量和分次，以及正常组织接受的剂量。此外，与患者就治疗目标进行坦诚的讨论同样重要。LAPC 的三个值得注意的策略是调强放射治疗、容积调制弧治疗和质子治疗。这些辐射方式倾向于改善目标体积的剂量分布，同时最大限度地减少对周围正常组织的辐射剂量。在肿瘤未侵入十二指肠或其他邻近结构的情况下，也可以考虑对 LAPC 患者进行立体定向放射治疗。由于立体定向放射治疗提供的高剂量，应实施适当的呼吸和肿瘤运动管理以减少附带辐射剂量。尽管现代放射方式、不断发展的技术和更准确的计划改善了临床结果，但未来的研究对于阐明 LAPC 患者放射治疗的最佳作用仍然至关重要。