PULSAR in Systemic Therapy for Pancreatic Cancer

Inclusion Criteria: * Age ≥ 19 years. * Eastern Cooperative Oncology Group (ECOG) performance status of 0-2. * Histologically confirmed pancreatic ductal adenocarcinoma. * Disease extent classified as borderline resectable, locally advanced, or oligometastatic disease (defined as ≤ 3 metastatic lesions) at the time of staging evaluation. * Completion of at least 2-4 cycles of first-line systemic therapy (FOLFIRINOX, gemcitabine/nab-paclitaxel, or NALIRIFOX) without evidence of distant progression. * Presence of a lesion suitable for radiotherapy, as determined by the investigator, and measurable disease per RECIST 1.1 criteria. * Ability to understand the study requirements and voluntarily provide written informed consent. Exclusion Criteria: * Pregnant or breastfeeding women. * Presence of brain metastases or leptomeningeal disease. * History of prior radiotherapy to the intended treatment area. * Significant comorbid conditions that may interfere with study participation or the ability to safely receive study treatment, as determined by the investigator (e.g., uncontrolled infection, congestive heart failure, clinically significant arrhythmia, or severe psychiatric illness). * Patients deemed unlikely to comply with study procedures or follow-up requirements. * Any condition that, in the opinion of the principal investigator or treating physician, makes the patient inappropriate for participation in this trial.