When is SBRT or hypofractionated radiation appropriate as adjuvant treatment for pancreatic cancer?

There may be a variety of opinions about this question. 33 Gy in 5 looks to be as least as good as 50.4 Gy in 28 in unresectable pancreatic cancer and has had some improved pathologic responses in borderline resectable pancreatic cancer in experienced hands (Hermann et al., PMID 25538019). However, ...

As @Dr. First Last outlines above, the management of resected pancreatic cancer is controversial and a “standard” adjuvant treatment approach has yet to be determined. We patiently await the results of RTOG 0848, the current cooperative group trial evaluating the role of conventional chemoradiation ...

Hypo will result in damage to surrounding tissues/organs if the patient lives >1 year. If the expected survival is 1 year or less (as is typical for pancreatic ca), then hypofractionated RT is fine.