Redefining the role of radiation therapy in pancreatic cancer management: innovations and future directions

Pancreatic ductal adenocarcinoma (PDAC) is a major health issue worldwide. Recent advances in systemic treatment are expected to break away from the long period of stagnation and improve treatment outcomes for this disease. Radiation therapy (RT), one of the main treatments used in the field of oncology, has not shown clear clinical benefits. Development in RT techniques such as the adaptation of computed tomography in RT planning, the use of motion control, image guidance, and particle beams have enabled high-precision, high-dose radiation delivery to tumors without increasing the risk of RT toxicity. With the application of these technical advancements, it is possible to shorten the conventional RT period from approximately 4 to 6 weeks to less than a week. The shortened duration of RT minimizes the impact of systemic treatment interruption on PDAC management and raises expectations of clinical benefits from the use of RT in various clinical situations. In this review, we discuss innovations in RT and future directions for its role in the management of PDAC.