Locally Advanced/Unresectable Pancreatic Cancer

When pancreatic cancer is not resectable or metastatic, it is classified as locally advanced pancreatic cancer. The majority of patients diagnosed with localized pancreatic cancer present with locally advanced disease. Currently, there is no consensus for optimal treatment of locally advanced pancreatic cancer. There has been much debate and controversy with regard to the best upfront treatment modality (chemotherapy and radiotherapy), sequencing of chemotherapy and radiation, and specific nuances of chemotherapy agents and radiation treatment techniques. The aims of treatment are to extend survival and improve quality of life by preventing development of distant metastatic disease and progression of local disease. Without surgery, the prognosis of these patients remains poor. This chapter provides a guide for management of locally advanced pancreatic cancer, with a predominant focus on radiation therapy planning.