AIM:To explore whether intensity modulated radiationtherapy (IMRT) in combination with chemotherapy couldincrease radiation dose to gross tumor volume without severeacute radiation related toxicity by decreasing the dose tothe surrounding normal tissue in patients with locallyadvanced pancreatic cancer.METHODS:Twenty-one patients with locally advancedpancreatic cancer were evaluated in this clinical trial.Patients would receive the dose of IMRT from 21Gy to30Gy in 7 to 10 fractions within two weeks afterconventional radiotherapy of 30Gy in 15 fractions over 3weeks.The total escalation tumor dose would be 51,54,57,60Gy,respectively.5-fluororacil (5-FU) or gemcitabinewas given concurrently with radiotherapy during thetreatment course.RESULTS:Sixteen patients who had completed theradiotherapy plan with doses of 51Gy (3 cases),54Gy (3cases),57Gy (3 cases) and 60Gy (7 cases) were includedfor evaluation.The median levels of CA19-9 prior to andafter radiotherapy were 716 U/ml and 255 U/ml respectively(P<0.001) in 13 patients who demonstrated high levels ofCA19-9 before radiotherapy.Fourteen patients whosuffered from pain could reduce at least 1/3-1/2 amountof analgesic intake and 5 among these patients gotcomplete relief of pain.Ten patients improved in Karnofskyperformance status (KPS).The median follow-up periodwas 8 months and one-year survival rate was 35 %.Nopatient suffered more than grade Ⅲ acute toxicities inducedby radiotherapy.CONCLUSION:Sixty Gy in 25 fractions over 5 weeks withlate course IMRT technique combined with concurrent 5-FUchemotherapy can provide a definitely palliative benefit withtolerable acute radiation related toxicity for patients withadvanced pancreatic cancer. AIM: To explore whether intense modulated radiation dose to gross tumor volume without severe acute radiation related toxicity by decreasing the dose tothe surrounding normal tissue in patients with locally advanced pancreatic cancer. METHODS: Twenty-one patients with locally advanced pancreatic cancer were evaluated in this clinical trial. Patients would receive the dose of IMRT from 21 Gy to 30 Gy in 7 to 10 fractions within two weeks afterconventional radiotherapy of 30 Gy in 15 fractions over 3 weeks. The total escalation tumor dose would be 51, 54, 57, 60 Gy, 5-fluororacil (5-FU) or gemcitabine was given concurrently with radiotherapy during the treatment course .RESULTS: Sixteen patients who had completed theradiotherapy plan with doses of 51 Gy (3 cases), 54Gy (3cases), 57Gy and 60 Gy (7 cases) were included for evaluation. The median levels of CA19-9 prior to and after radiotherapy were 716 U / ml and 255 U / ml res Pectively (P <0.001) in 13 patients who presented high levels of CA19-9 before radiotherapy. Fourteen patients whosuffered from pain could reduce at least 1 / 3-1 / 2 amount of analgesic intake and 5 among these patients got complete relief of pain. Ten patients improved in Karnofskyperformance status (KPS). The median follow-up period was 8 months and one-year survival rate was 35% .Nopatient recovered more than grade Ⅲ acute toxicities inducedby radiotherapy. CONCLUSION: Sixty Gy in 25 fractions over 5 weeks withlate course IMRT technique combined with concurrent 5-FUchemotherapy can provide a definitely palliative benefit withtolerable acute radiation related toxicity for patients withadvanced pancreatic cancer.