Carbon Ion Radiotherapy for Recurrent Pancreatic Cancer Post Surgery

Inclusion Criteria:

1. The histologically or cytologically confirmed pancreatic adenocarcinoma;
2. Local-regional recurrent pancreatic cancer post surgery, no evidence of distantmetastases, based upon Positron Emission Tomography, CT, or MRI images of the chest,abdomen and pelvis within 30 days prior to registration;
3. Eastern Cooperative Oncology Group Performance Status 0-1 within 30 days prior toregistration;
4. Age of ≥ 18 years old;
5. Enough hematological function (white blood cell count ≥ 3.0×109/L; platelets ≥50×109/L; hemoglobin ≥ 90 g/L);
6. Enough liver and kidney functions (creatinine <110gmol/L; urea nitrogen <7.1mmol/L;bilirubin < 1.5 x ULN, alanine aminotransferase and aspartate aminotransferase ≤ 2.5 xULN);
7. Informed consent form obtained.

Exclusion Criteria:

1. Eastern Cooperative Oncology Group Performance Status >=2；
2. Liver, kidney and bone marrow function are poor and not adequate for treatment;
3. GI was invaded by recurrent lesions;
4. Prior radiation therapy to the abdomen or radioactive particle implantation or otherlocal treatment for the recurrent lesions;
5. Cardiac pacemaker or other metal implantation whose function may be disturbed by highenergy beam or which affect the dose in target volume;
6. Dose constrain of normal liver, digested system and other organ at risk could notreach the expecting safe dose constrain;
7. The patient could not get benefit from proton or heavy ion radiotherapy in physician'sopinion;
8. Comitant diseases which could affect the proton or heavy ion radiotherapy;
9. Pregnancy（blood or urine β-human chorionic gonadotropin certified）or lactation;
10. Drug or alcohol abused;
11. HIV positive, including received anti-retrovirus treatment; chronic hepatitis B virusreplication stage; hepatitis C active stage; syphilis active stage;
12. hepatitis B virus positive, hepatitis B virus replication stage, need to be treatedwith anti-virus treatment, but could not receive anti-virus treatment because ofcomitant disease;
13. Psychiatric history, possibly affecting the completion of treatment;
14. Patients with serious complications that might affect radiotherapy， including 1）unstable angina pectoris requiring hospitalization in the last 6 months，congestiveheart failure，myocardial infarction； 2）acute bacterial or systemic fungal infections； 3）exacerbation of chronic obstructive pulmonary disease ( COPD) or other respiratorysystem disease requiring hospitalization 4）hepatic function insufficiency or renalfunction insufficiency 5） immunosuppressed patients
15. patients with connective tissue disease such as active scleroderma or lupus and so on,which is contraindication for radiotherapy
16. patients can't understand treatment goal or unwilling/unable to sign up inform consentform；
17. no civil capability or limited civil capacity.