Radiotherapy for pancreatic cancer

What is radiotherapy?

Radiotherapy uses radiation to destroy cancer cells. A machine called a linear accelerator (linac) is usually used to deliver radiotherapy for pancreatic cancer. This directs beams of radiation at the cancer from outside the body, destroying the cancer cells.

If you have pancreatic cancer, you may have radiotherapy on its own, or together with chemotherapy. This is called chemoradiotherapy.

Who can have radiotherapy?

Radiotherapy is used in different ways, depending on your diagnosis. It may be used after, and occasionally before, surgery to remove the cancer.

• Borderline resectable pancreatic cancer is cancer that has grown very close to the major blood vessels near the pancreas. Chemotherapy together with radiotherapy may be suitable for some people with borderline resectable cancer. The aim is to shrink the cancer enough to make it possible to remove it with surgery. Sometimes radiotherapy may be used on its own, but this is less common.
• Locally advanced pancreatic cancer is cancer that has spread to the large blood vessels near the pancreas, or to several lymph nodes. If you have locally advanced cancer, you may be offered chemoradiotherapy. Chemoradiotherapy may help control the cancer and slow down its growth. Another option may be a very precise type of radiotherapy called , following 3 months of chemotherapy. SABR delivers higher doses of radiation in a shorter time.
• If you have cancer that has spread to other parts of the body (advanced or metastatic cancer) it can cause pain. You may be able to have radiotherapy to help the pain. This is called palliative radiotherapy.

Read more about whether radiotherapy might be an option for you, depending on your cancer.

How will I have radiotherapy?

You will normally have a planning session before your radiotherapy starts, so that the radiotherapy team can make a treatment plan for you. You will have a planning CT scan, and the radiographers will make tiny permanent dots (tattoos) on your skin. They will use these tattoos to get you into exactly the right position for each treatment session.

You will usually go to the hospital Monday to Friday for your radiotherapy. The treatment session may take about 30 minutes each time, or 45 minutes to more than an hour for SABR. The radiotherapy machine will move around you during treatment, but will not touch you.

You will usually have scans or X-rays taken while you are having radiotherapy to check that you are in the right position during treatment.

You can go home as soon as each treatment session has finished. Radiotherapy and chemoradiotherapy can be tiring, so it might help if someone drive you to hospital.

Read more about how radiotherapy is given.

How will I have chemoradiotherapy?

If you are having chemoradiotherapy, you will usually have chemotherapy on its own for three to six months to begin with. You will then have a CT scan. If this shows that the cancer has not grown, you will have radiotherapy and chemotherapy every day from Monday to Friday, for five to six weeks.

The chemotherapy drug most often used with radiotherapy is capecitabine, which is taken as a tablet.

Are there any side effects?

Radiotherapy and chemoradiotherapy can cause some short and longer term side effects but these are often mild. Side effects include:

• fatigue (extreme tiredness)
• feeling and being sick (nausea and vomiting)
• runny poo (diarrhoea)
• skin changes, such as dry skin
• a small risk of long term bowel damage – this is rare.

If you have chemoradiotherapy, you may also get side effects from the chemotherapy.

Your medical team will carefully plan your treatment to reduce the risk of any side effects, and there are ways to manage side effects.

Published January 2022

To be reviewed January 2024