Radiotherapy for Locally Advanced Pancreatic Carcinomas (Phase II Trial)

Inclusion Criteria:

1. The patient has histologically or cytological confirmed diagnosis of pancreatic cancer (cases with radiological findings suspicious of pancreatic cancer AND elevated CA 19-9 may be enrolled even without positive cytology)
2. The patient is not candidate for radical surgical resection because of one or more of the following reasons:

   1. the patient is staged as locally advanced and with unresectable disease according to the international consensus definition. Specific criteria are: there is involvement of portal vein/superior mesenteric vein with bilateral narrowing/occlusion, exceeding the inferior border of the duodenum; or tumor contact/invasion of 180 or more degree of the superior mesenteric artery or of the truncus coeliacus; or tumor contact/invasion of the proper hepatic artery/ celiac artery; or tumor contact or invasion of the aorta.
   2. the patient is not a candidate for radical surgery because of radiographic or biochemical (CA 19-9) progression during neoadjuvant chemotherapy despite being initially classified as resectable or borderline resectable according to the international consensus definition.
   3. the patient is not candidate for radical surgery because of cN+ stage
3. The patient is not candidate to (further) neoadjuvant chemotherapy because of one or more of the following reasons:

   1. the patient is not fit for chemotherapy
   2. the patient has progressed under chemotherapy
   3. the patient has received neoadjuvant chemotherapy but is judged still not a candidate for explorative surgery.
4. Negative staging for distant metastasis
5. Age \> 18 years
6. Karnofsky index ≥ 70
7. No tumor infiltration of stomach or duodenum
8. The patient is informed of the diagnosis and is able to give informed consent (Ability of patient to understand character and individual consequences of the study protocol)
9. Women of fertile age must have adequate conception prevention measures and must not breast feed
10. Signed Informed Consent (must be available before study inclusion)

Exclusion Criteria:

1. Non-exocrine tumors
2. Major medical or psychiatric comorbidities that contraindicate radiotherapy
3. Presence of distant metastasis
4. Pregnancy or unwilling to do adequate conception prevention
5. Lactating and unwilling to discontinue lactation
6. Men of procreative potential not willing to use effective means of contraception
7. Metallic prosthesis or other conditions - IF it prevents an adequate imaging for target volume definition or treatment planning at the discretion of the treating institution contraindicate radiotherapy e.g. active infections in the area
8. Previous abdominal radiotherapy
9. Severe hepatic or renal impairment at discretion of treating institution
10. Patient refusal