At presentation, 30% of patients with pancreatic adenocarcinoma will have locally advanced unresectable disease. Optimal management of these patients has been unclear because no widely accepted international standard approach exists. Compared with patients with distant metastatic disease, patients with locally advanced unresectable disease have a slightly improved prognosis. Thus, it has been tempting to maximize local control with chemoradiotherapy. However, randomized clinical trials to date have failed to demonstrate a clear benefit in this patient subgroup for reasons including underpowered trials, poor accrual, lack of optimal systemic therapy or radiation therapy, and lack of radiation quality control. Moreover, a significant limitation of chemoradiation remains the disease biology itself—namely, the high prevalence of occult metastatic disease, rendering many patients unlikely to benefit from a local therapy approach.
Vaccaro G, Lopez CD. Chemoradiation for Locally Advanced Unresectable Pancreatic Cancer—What Now?. JAMA Oncol. Published online August 04, 2016. doi:10.1001/jamaoncol.2016.3012