Global practice patterns of radiotherapy utilization in pancreatic adenocarcinoma.

670 Background: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer requiring multi-modality treatment. Radiotherapy (RT) may improve local control and resection rates, particularly in patients with borderline resectable or locally advanced disease. This study aimed to characterize international practice patterns and provider perspectives on RT use in PDAC and to identify factors associated with its utilization. Methods: A 39-item electronic survey was distributed between June 2025 and August 2025 via the Radiosurgery Society, International Hepato-Pancreato-Biliary Association, and Pancreas Club listservs to providers who have treated at least one PDAC patient in the last 5 years. The questionnaire was developed based on expert consensus and pilot tested to address institutional characteristics, multidisciplinary team access, patient volumes, and RT practices. Results: A total of 176 PDAC providers from six continents completed the survey, with the majority practicing in Europe ( n = 74, 43%), North America ( n = 67, 37%), and Asia ( n = 20, 11%). Respondents included mostly surgeons ( n = 143, 80%) and radiation oncologists ( n = 27, 15%), with 80% ( n = 143) practicing in academic centers. Nearly 1 in 5 respondents did not offer or consider any indication for neoadjuvant ( n = 30, 17%) or adjuvant ( n = 45, 31%) RT. The most commonly cited indication for neoadjuvant RT was for locally advanced disease ( n = 89, 51%) or local tumor progression on chemotherapy ( n = 80, 46%), while the use of adjuvant RT was primarily for positive surgical margins ( n = 90, 63%) and positive nodal disease ( n = 41, 28%). Compared to Europe, providers in North America were more likely to offer neoadjuvant RT for patients with resectable (24.4% vs. 56.1%), borderline (25.3% vs. 55.2%), and locally advanced PDAC (30.3% vs. 48.7%) (all p < 0.005). Conclusions: Significant variation exists in the use of RT for PDAC globally. These findings underscore the need for consensus guidelines based on prospective data to guide RT utilization in PDAC patients.