ASTRO Updates Pancreatic Cancer Radiation Guidelines

The American Society for Radiation Oncology (ASTRO) published an updated clinical practice guideline for radiation therapy in pancreatic cancer, revising its 2019 recommendations. The guideline, authored by Chuong et al. and published in Practical Radiation Oncology, incorporates evidence from recent clinical trials and provides recommendations across resectable, borderline resectable, locally advanced, recurrent, metastatic, and palliative settings. Key updates include strong recommendations for preoperative radiation in borderline resectable disease, dose escalation for locally advanced disease when image guidance and motion management are available, and the use of stereotactic body radiation therapy (SBRT) for oligometastatic disease. The guideline also emphasizes multidisciplinary care, precision techniques such as IMRT and adaptive radiation, and highlights the potential of integrating radiation with emerging RAS-targeted therapies like daraxonrasib from Revolution Medicines. Developed in collaboration with ASCO, ESTRO, and SSO, the guideline aims to clarify when radiation therapy is appropriate and how to deliver it safely, reflecting advances in systemic therapy that have improved survival and expanded the role of local treatments.