Role of Radiotherapy in the Management of Pancreatic Adenocarcinoma: Debate and Discordance in Clinical Trials

Pancreatic adenocarcinoma (PAC) is an extremely fatal malignancy with dismal outcome with standard treatment till date. Investigators are constantly in search of optimal treatment approach and radiation therapy (RT) remains in the centre of debate. Human pancreatic cancer cell lines have shown both intrinsic and hypoxia induced radio resistance, and RT has produced conflicting results as well in the various clinical trials. However, most of the American studies continued the use of RT as a potential treatment modality but the European school of thought is widely criticized for their ‘therapeutic nihilism’ towards radiation and faulty clinical trial designs. This article has reviewed the available literature on the evolving role of RT for the management of resectable and borderline resectable PAC and has highlighted the increasing trend towards the use of radiotherapy for both adjuvant and neo adjuvant treatment. With the advent of modern RT techniques, the acute and late toxicities are much less than the earlier time, and therefore augmented RT is expected to produce better clinical outcomes for the patients with pancreatic carcinoma.