What is your approach to locally advanced pancreatic cancer that has not progressed after neoadjuvant chemotherapy +/- chemoradiation but remains unresectable?

NRG GI011 was recently activated across the NCTN and will test ablative radiotherapy in this setting. This is a pragmatic and potentially practice-changing trial. Consider activating it at your center. Here is a nice summary from the PI @Dr. First Lasthttps://www.youtube.com/watch?v=MNsS7pHqZIk.

As alluded to in the question stem, this is one of the only settings in which I consistently use XRT in the treatment of PDAC. I will also ensure that the patient has received both major chemo regimens (G/A and mFOLFIRINOX) if they are well enough to tolerate them (in case their cancer responds bett...

I hold treatment after completion of radiation therapy for the same reason outlined by Dr. @Dr. First Last. Patients appreciate this “treatment holiday,” and most feel well during the time off therapy. In addition, I am unaware of data showing that maintenance chemotherapy improves outcomes in LAPC....

Initial unresectable pancreas, but without DM or peritoneal deposits or effusion, is a subset. Choice of chemo alone vs chemo RT is certainly worth the consideration, sometimes hoping for conversion to resectability. Problems to that are commonly vascular…but admittedly a subset of a subset.

SBRT or...

After 6 months or so, switch to radiotherapy.