Radiotherapy for pancreatic cancer uses a machine outside the body to aim radiation beams at the tumor. This treatment can be used at various stages of the disease. In some cases, it’s used at the start of treatment, particularly for tumors that are “borderline resectable” (meaning they are close to major blood vessels and difficult to remove) or “locally advanced” (meaning they have grown beyond the pancreas but have not yet spread to distant parts of the body). In these situations, radiotherapy is often given along with chemotherapy before surgery to help shrink the tumor and make it easier to remove completely, or to control the cancer’s growth.
What is Radiotherapy for Pancreatic Cancer?
Radiotherapy is a localized cancer treatment that uses high-energy radiation, such as X-rays, to damage the DNA of cancer cells and prevent them from growing or spreading. For pancreatic cancer, doctors typically use a form called external radiotherapy, which involves a machine outside the body directing radiation beams at the tumor. The goal is to target the cancerous cells while sparing the healthy tissues and organs nearby.
Radiotherapy may be used at various stages of the disease. In some cases, it can be given before surgery (neoadjuvant) to shrink the tumor and make it easier to remove, or after surgery (adjuvant) to kill any remaining cancer cells. For tumors that cannot be surgically removed, radiotherapy is used to slow the cancer’s growth, control the size of the tumor, and help manage symptoms like pain. This treatment is often given in combination with chemotherapy, a practice known as chemoradiation, which helps the radiation work more effectively.
How is Radiotherapy for Pancreatic Cancer Administered?
The process of administering radiotherapy is carefully planned and delivered. It is typically an outpatient treatment, and the patient does not need to stay overnight in a hospital.
Planning the Treatment
Before the first session, a team of specialists, including a radiation oncologist and medical physicists, creates a personalized treatment plan. This involves:
- Imaging: A CT scan is used to precisely locate the tumor and map its relationship to nearby healthy organs. Sometimes, other scans like MRI or PET/CT are also used.
- Contrast Agents: To help distinguish organs more clearly on the scan, you may be given a contrast drink or an injection of a dye.
- Positioning Marks: To ensure you are in the exact same position for every session, a few tiny, permanent tattoos or temporary ink marks are placed on your skin. These marks serve as guides for the radiographers.
- Computer-Assisted Planning: The scans and marks are used to create a detailed treatment plan that calculates the exact dose of radiation needed and ensures the tumor gets the highest dose while healthy tissue is spared.
Delivering the Treatment
Once the plan is ready, the treatment sessions begin. Each session is a small dose, or “fraction,” that contributes to the total prescribed dose.
- The Machine: The radiation is delivered by a large machine called a linear accelerator (LINAC). This machine can rotate around the treatment table to direct beams at the tumor from multiple angles.
- The Session: You will lie on a treatment table, and a radiographer will position you precisely using the marks on your skin. The radiographers will leave the room to operate the machine, but they will monitor you via cameras and can communicate with you through an intercom.
- No Pain: The treatment itself is painless. You may hear some noise from the machine, but you won’t feel the radiation. It is important to lie as still as possible during the session, which typically lasts only a few minutes, though the entire appointment may take longer.
- Frequency: For standard external beam radiotherapy, treatment is usually given five days a week for several weeks. Other types of therapy, like Stereotactic Body Radiation Therapy (SBRT), deliver a higher dose in fewer sessions (e.g., 1-5 sessions).
Some advanced techniques are used to improve accuracy, such as MRI-guided radiation therapy, which uses real-time imaging during the session to track the tumor’s movement with breathing and adjust the beam accordingly.
Side Effects of Radiotherapy for Pancreatic Cancer
Radiotherapy for pancreatic cancer can be effective in controlling tumor growth and easing symptoms, but because the pancreas lies close to the stomach, intestines, liver, and kidneys, healthy tissues can also be affected. As a result, patients may experience side effects, which are usually temporary but can sometimes persist long after treatment.
Short-Term Side Effects of Radiotherapy for Pancreatic Cancer
The short-term side effects of radiotherapy for pancreatic cancer are primarily related to the abdominal area and tend to get better within a few weeks after treatment ends.
Patients often feel tired and may lack energy, and this fatigue can get worse as the treatment progresses. Gastrointestinal issues are frequent and can include nausea, vomiting, and diarrhea, as well as a poor appetite. The skin in the treated area can also become red or darker and may feel sore, but this usually resolves within 2 to 4 weeks after the treatment is over.
Additionally, some people may experience reflux, which is when stomach acid flows up into the esophagus. The texts explain that these effects build up over the course of treatment, often peaking 4 to 5 weeks after the first session. However, they typically begin to improve about 1 to 2 weeks after the full treatment course is finished.
Long-Term Side Effects of Radiotherapy for Pancreatic Cancer
The survival rate for pancreatic cancer is often poor, which makes it challenging to study and define long-term side effects from treatments like radiotherapy.
The prognosis for pancreatic cancer is consistently serious, with a low five-year survival rate. Most cases are diagnosed at an advanced stage, meaning the cancer has already spread. This is why a key reason it is difficult to study long-term side effects is that many patients do not live long enough for these effects to manifest.
The provided texts state that late side effects are “uncommon” and may include damage to organs such as the liver, kidneys, stomach, or small bowel. They also mention that late toxicity was observed in a small percentage of patients (0% to 5.3% in some studies). This low incidence is, in part, a reflection of the disease’s aggressive nature and low long-term survival rates.
How Long Does It Take to See Results?
For locally advanced pancreatic cancer, follow-up to check how well the radiotherapy has worked is typically scheduled for a period after treatment is completed. For example, a patient who has undergone Stereotactic Body Radiation Therapy (SBRT) may have a CT scan 6 to 8 weeks after their treatment finishes to assess the results. For other types of radiotherapy, such as chemoradiotherapy, a patient might have a check-up with their oncologist four to six weeks after finishing treatment, and a CT scan about 12 weeks after the radiotherapy ends.
How Many Radiotherapy Sessions for Pancreatic Cancer?
The number of radiotherapy sessions for pancreatic cancer varies significantly depending on the type of treatment used and its purpose.
- Chemoradiotherapy: When radiotherapy is combined with chemotherapy, it is typically given once a day, Monday through Friday, for a course that lasts 4 to 6 weeks.
- Stereotactic Body Radiation Therapy (SBRT): This advanced form of radiotherapy delivers higher doses of radiation in fewer sessions. Patients typically receive 1 to 5 sessions, often scheduled over a period of one to two weeks.
- Palliative Radiotherapy: For patients receiving radiotherapy to relieve symptoms like pain, the number of sessions is much lower. It can sometimes be as few as a single treatment, or a few fractions over one to three weeks.
The choice of treatment schedule is determined by your healthcare team based on factors such as the type and stage of the cancer.
What Are The Recent Advances in Radiotherapy for Pancreatic Cancer?
In a systematic review and meta-analysis by Wu et al., published in 2025 in the International Journal of Radiation Oncology, Biology, Physics, researchers compared neoadjuvant chemotherapy (NAC) alone to a combination of neoadjuvant chemotherapy and chemoradiation therapy (NAC-CRT) for resectable or borderline resectable pancreatic adenocarcinoma. The study found that NAC alone resulted in significantly longer overall survival (25.55 months) compared to NAC-CRT (17.55 months).
However, NAC-CRT was associated with a significantly higher rate of R0 resection (a complete surgical removal with no cancer cells at the edges of the tissue), at 83.43% compared to 69.97% for NAC alone. The study concludes that while NAC alone offers longer overall survival, the addition of chemoradiation improves the chances of a complete resection, and this local benefit can lead to extended survival when patients receive five or more cycles of initial chemotherapy.
In a systematic review by Shouman et al., published in 2024 in Clinical and Translational Radiation Oncology, the authors summarized the current evidence for Stereotactic Body Radiotherapy (SBRT) for pancreatic cancer. The review included 31 studies with 1,571 patients and found that SBRT shows promising results in several clinical contexts. For locally advanced pancreatic cancer (LAPC), SBRT demonstrated favorable local control rates and even allowed some patients to undergo surgery, with resection rates reaching up to 39%.
For borderline resectable pancreatic cancer (BRPC), the combination of SBRT with modern systemic therapies led to remarkable resection rates of up to 80%. The review also highlighted the potential of magnetic resonance-guided radiotherapy (MRgRT) to deliver ablative doses while minimizing severe side effects. While there are limited prospective data, SBRT also appears to be effective for isolated local recurrence (ILR) and for palliative pain relief, but it does not seem to offer a significant advantage over chemotherapy as an adjuvant therapy after a radical resection.
Read OncoDaily’s Special Article About Stereotactic Radiotherapy
How Can Patients Support Their Health During Radiotherapy For Pancreatic Cancer?
Patients with lung cancer can support their health during radiotherapy by focusing on several key areas: nutrition, rest, physical activity, and emotional well-being.
Nutrition and Hydration
Eating a well-balanced diet high in protein and healthy fats is crucial for repairing tissues and maintaining muscle mass. Protein sources like eggs, lean meats, fish, nuts, and dairy are particularly important. Some foods, like spicy or acidic options, may be hard to tolerate if side effects like throat pain, nausea, or mouth sores occur. Eating small, frequent meals and opting for soft, moist foods can help manage these symptoms. Staying well-hydrated is also vital to combat fatigue and prevent dehydration. You should drink plenty of fluids, and your care team may suggest beverages like broths, juices, or sports drinks to help you stay hydrated and get extra calories.
Rest and Activity
Feeling tired is a very common side effect of radiotherapy, and this fatigue can be worsened by travel for appointments or by other treatments. It is important to get enough rest and sleep. However, balancing rest with gentle physical activity is also beneficial. Light exercise like short walks or stretching can help reduce fatigue, improve your mood, and maintain a healthy weight.
Emotional and Mental Support
Managing the emotional and mental toll of a cancer diagnosis and treatment is as important as managing physical symptoms. Many patients experience anxiety, fear, or frustration. Seeking psychosocial support can be very helpful. This can include talking with a counselor, joining a support group with other cancer patients, or simply leaning on your friends and family for emotional support.
Communication with Your Healthcare Team
Throughout your treatment, it is essential to stay in close communication with your cancer care team. You should report any side effects you experience, as many can be managed with medication or dietary adjustments. It is also critical to inform your doctor about any over-the-counter medicines, vitamins, herbal remedies, or supplements you are taking, as some may interfere with the effectiveness of the radiation therapy.
Written by Aren Karapetyan, MD
FAQ
What is radiotherapy and why is it used for pancreatic cancer?
Radiotherapy is a cancer treatment that uses high-energy radiation, such as X-rays, to damage and kill cancer cells. It is a localized treatment used to either shrink tumors before surgery, eliminate remaining cancer cells after surgery, or slow tumor growth and manage symptoms for tumors that cannot be removed.
How is radiotherapy for pancreatic cancer administered?
The treatment is administered by a large machine called a linear accelerator (LINAC), which directs radiation beams at the tumor. The process is carefully planned using CT scans to ensure precise targeting. Patients lie on a table while the machine rotates around them. The treatment is painless and typically given in outpatient sessions.
What is the difference between standard radiotherapy and SBRT?
Standard radiotherapy for pancreatic cancer is usually given in small daily doses over several weeks (e.g., 4 to 6 weeks). SBRT (Stereotactic Body Radiation Therapy) is a more advanced technique that delivers a much higher dose of radiation in a very short course, typically over 1 to 5 sessions. SBRT is designed to be more precise and reduce the impact on healthy tissues.
What are the common short-term side effects of this treatment?
Since the treatment targets the abdomen, common short-term side effects include fatigue, nausea, vomiting, diarrhea, loss of appetite, and skin irritation in the treated area. These side effects tend to worsen during treatment and usually begin to improve a week or two after the treatment course is finished.
Why is it hard to define long-term side effects?
The prognosis for pancreatic cancer is often serious, as it is frequently diagnosed at an advanced stage. Because of the aggressive nature of the disease, many patients unfortunately do not live long enough for long-term side effects (those appearing months or years after treatment) to become a major factor or to be comprehensively studied.
What is chemoradiation?
Chemoradiation is a combined treatment approach where chemotherapy drugs are given at the same time as radiotherapy. The chemotherapy acts as a radiosensitizer, which means it makes the cancer cells more vulnerable to the effects of the radiation, improving the overall effectiveness of the treatment.
How long does a typical treatment course last?
The duration of treatment varies. A course of chemoradiation can last for 4 to 6 weeks, with daily sessions. A course of SBRT is much shorter, typically lasting only 1 to 2 weeks over a few sessions.
What is palliative radiotherapy and how is it different?
Palliative radiotherapy is used to relieve symptoms like pain and bleeding in advanced cancer cases, rather than to cure the disease. It is a shorter treatment, sometimes consisting of just a single session, and uses lower doses of radiation, which also results in fewer side effects.
How long does it take to see results?
The effects of radiotherapy are cumulative and build up over time. The texts do not provide a specific timeframe to see results. Follow-up scans, like a CT, are typically scheduled several weeks after the treatment is completed (e.g., 6 to 8 weeks after SBRT) to check how well the treatment has worked.
How can I prepare for and support my health during radiotherapy?
Preparation involves discussing your health with your care team and confirming any medications or supplements you take. During treatment, supporting your health includes staying well-rested, maintaining a healthy diet, and managing side effects with the help of your doctors. Gentle physical activity and seeking emotional support can also be very helpful.