Radiotherapy

Patients with good performance status and localized resectable tumour may be considered for radiotherapy, with or without chemotherapy. Moertel showed that 5FU increased median survival after radiotherapy (35-40 Gy) by 4 months (10.4 months vs 6.3 months). With 3D-CT planning of external-beam radiotherapy it is possible to deliver 50.4 Gy in 28 daily fractions to pancreatic tumours without exceeding tolerance for the adjacent stomach, bowel, or kidneys.

Both external-beam radiotherapy (EBRT) and intra-operative radiotherapy (IORT) have been used in the adjuvant settings. The EORTC and ESPAC-1 randomized controlled trials have shown no benefit from adjuvant chemoradiotherapy.

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