This study from Japan reported clinical outcomes of 200 patients with locally advanced pancreatic cancer (LAPC) treated with PT to a total dose of 67.5 GyE in 25 daily fractions and concurrent chemotherapy. The OS rate at 1- and 2-year after PT was 69.6% and 35.4% with a median OS of 18.4 months. The 1- and 2-year LC and PFS rates were 84.3% and 68.0%, and 44.3% and 19.4%, respectively. Acute grade ≥ 3 hematologic toxicity was observed which was thought to be caused by chemotherapy. Grade 3 toxicities including gastrointestinal bleeding/ulceration, nausea/vomiting, anorexia, and dermatitis, were observed in 15 (7.5%), 3 (1.5%), 2 (1.0%), and 2 (1.0%) patients, respectively. Late grade 3 gastrointestinal bleeding/ulcer was observed in 14 patients (7.0%), and there was one case (0.5%) of grade 5 toxicity. The authors suggested that these results were comparable to other intensive chemotherapy regimens and to chemoradiotherapy regimens. proton radiotherapy for LAPC may be a valuable multidisciplinary treatment option.