Radiotherapy in Pancreatic Cancer: To Whom, When, and How?

Simple Summary The prognosis of pancreatic cancer is always serious. In most cases, the cancer is diagnosed at an advanced stage. The treatment is based on the combination of many treatment methods. In the presented work, we focus on the analysis of the role of radiotherapy in the radical treatment of pancreatic cancer. Radiotherapy in combination with chemotherapy or as stereotactic radiotherapy after chemotherapy contributes to the improvement of the results of preoperative treatment in pancreatic cancers with borderline resectability. In locally advanced cases, the use of radiotherapy increases the probability of local cure and reduces the intensity of pain. Therefore, the use of radiotherapy in subsequent stages of treatment in patients with locally advanced pancreatic cancer should be considered. The diagnosis rate of pancreatic cancer is steadily increasing. The average age of onset is close to 70 years. In most cases, the disease is diagnosed at an advanced stage. The indications for and techniques of radiotherapy are changing over time. The aim of this thesis is to present the role and possibilities of radiotherapy from the perspective of radiation oncologist. The most common cause of treatment failure in pancreatic cancer remains generalisation. The implementation of new systemic treatment regimens contributes to improved treatment outcomes regardless of the stage of the disease. With improved treatment outcomes in terms of the incidence of distant metastases, the impact of local curability on the length and quality of life of patients increases. Modern radiotherapy offers the opportunity to achieve high local cure rates. Postoperative radiotherapy in combination with chemotherapy seems justified in the group of postoperative pancreatic cancer patients with pT3 and pN+ features. In the group of patients with borderline resectable pancreatic cancer, the impact of radiotherapy in combination with the latest chemotherapy regimens is difficult to define clearly. In the setting of a diagnosis of advanced pancreatic cancer, radiotherapy, especially stereotactic radiotherapy, in combination with chemotherapy, contributes to improved local curability and allows to achieve a significantly reduced level of pain.