雖然僅僅佔臺灣全部癌症診斷的2% ，胰臟癌卻名列臺灣十大癌症死因，也是最難處理的惡性腫瘤之一。在診斷初期，只有10-15% 的胰臟癌是可切除的。約有30% 的胰臟癌在診斷初期雖為局部局限性，卻無法切除。基於少數隨機分配臨床研究結果，我們對於局部侵犯性胰臟癌病患，給予合併化學與放射治療。最近的統合分析顯示，接受合併化學與放射治療的病患存活期，優於僅接受放射治療者；但與僅接受化學治療的局部侵犯性胰臟癌病患存活期，並無統計學上有意義的差異。由於類似的臨床結果與較低的副作用，許多臨床醫師以 gemcitabine 為主的化學治療，作為局部侵犯性胰臟癌病患的標準治療。然而，放射治療在局部侵犯性胰臟癌的角色，仍有許多爭議。本篇綜論針對放療角色，整理目前對局部侵犯性胰臟癌的處理方式、選擇與爭議，以及未來發展方向；也將報告我們最近完成的第二相臨床試驗中結果（TCOG1204）：於局部侵犯性胰臟癌，以引導式化學治療再給予合併化學與放射治療的治療策略。

Even though pancreatic cancer accounts for only 2% of all cancer diagnoses in Taiwan, it is one of the ten leading causes of cancer death and the most difficult malignancy to manage. Because of the usually late onset symptoms, half of the patients presented with metastatic disease. Only 10-15% of patients had resectable disease at initial diagnosis.
Around 30% of patients present with locally advanced disease that
precludes resection. The use of chemoradiotherapy for locally advanced pancreatic cancer (LAPC) is based on few randomized trials. Recent meta-analysis revealed a survival benefit for chemoradiotherapy over radiotherapy alone; however, chemoradiotherapy did not demonstrate significant survival advantage over chemotherapy alone.Because of similar outcome and lower toxicity, gemcitabine based chemotherapy is considered as a standard of care in many clinical situations. However, there is much controversy about the role of radiotherapy in local disease control. This paper reviews the current management options, controversies, and ongoing and future directions for the treatment of LAPC, focusing on the role of radiotherapy. The rationale and results of our phase II study on LAPC using induction chemotherapy followed by chemoradiation (TCOG1204) will be presented.