Global Perspectives on Radiotherapy Utilization for Pancreatic Ductal Adenocarcinoma

Abstract Purpose Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy requiring multi-modality treatment. Radiotherapy (RT) may improve local control and resection rates, though evidence to support use across various stages of disease is mixed and evolving. This study sought to investigate international practice patterns and provider preferences for the use of radiotherapy in the multidisciplinary management of PDAC. Methods A 39-item electronic survey was distributed in 2025 through three sub-specialty organizations to providers who have recently treated PDAC. Results A total of 176 PDAC providers from six continents completed the survey, with the majority practicing in Europe ( n = 76, 43%) and North America ( n = 62, 35%). Respondents included mostly surgeons ( n = 143, 81%) with 81% ( n = 142) practicing in academic centers. Nearly 1 in 5 respondents did not offer or consider any indication for neoadjuvant ( n = 32, 19%) or adjuvant ( n = 46, 30%) RT. The most commonly cited indication for neoadjuvant RT was for locally advanced disease ( n = 88, 52%) and surgically unresectable disease ( n = 86, 51%), while the use of adjuvant RT was primarily for positive surgical margins ( n = 97, 63%) and positive nodal disease ( n = 46, 30%). Conclusion In an international cohort of surgeons and radiation oncologists, there is substantial variation in perceptions of effectiveness, management preferences, and the propensity to utilize radiotherapy for PDAC. These results underscore the lack of strong evidence to support management, and the need for consensus guidelines and clinical trials to inform best practice.