Pancreatic cancer is a challenging disease to treat because it always annoys patients and oncologists.Even if patient was diagnosed as a resectable pancreatic carcinoma of early stage, the 5 years survival rates of pancreatic carcinoma were showed only about 20% after pancreatectomy combined with or without adjuvant systemic therapy.For pancreatic cancer, the new approach is necessary.The intraoperative radiotherapy (IORT) can be applied with the electron beam irradiation offers distinct advantages of high dose uniformity in the target volume and in minimizing dose to deeper tissues.Tokyo metropolitan cancer & infection center komagome hospital (CICK) introduced IORT for resectable and unresectable pancreatic cancer in 1976, and IORT followed by systemic chemotherapy (CT) or chemoradiation therapy (CRT) from the 1980s.To have a better understanding of the IORT, our team investigated the efficacy of IORT combined with postoperative external beam radiation therapy (EBRT)followed by systemic chemotherapy with 5-fluorouracil (5FU) and/or gemicitabine (GEM) for locally advanced pancreatic cancer.Between 1997 and 2005, 162 eligible patients had been analyzed.The dose of IORT was prescribed 20Gy/1Fr for resectable pancreatic cancer, 25Gy/1Fr for unresection group, and 50Gy/25Fr could be used in EBRT after operation.The data showed median follow-up month, 3-year over survival (OS) and local control (LC)rates treated with IORT plus adjuvant CRT for the entire cohort were 16.2 months, 32%, 63% for resection group and 9.9 months, 32%, 36% for unresection group.Late radiation-induced complications included radiation gastric ulcer (2 cases), jejunal artery bleeding (1) and was seen in approximately 1.9% of all cases.The results give us important message that the high prescribed dose could improve local control of locally advanced pancreatic cancer and it will not induce higher rates of late side effect of the disease surrounding tissue.Based on the results, mainly for the purpose of increasing resectable rate, our team designed a new prospective protocol that patients with locally advanced but non-metastatic pancreatic cancer should be offered definitive neoadjuvant CRT (nCRT) from August 2008.TS-1 (tegafur-gimeracil-oteracil potassium)with or without GEM chemotherapy can be considered by the performance status of patient for combined with CRT.For a period of one month after nCRT, whether the pancreatetomy with IORT or IORT alone can be applied according to CT/MRI imaging study and intraoperative pathology for the patient with locally advanced pancreatic cancer.Our team will analyze and present the latest data, and share our experience with you.