Welcome back to Rad Onc Smart Review, GI Series. Pancreatic cancer carries one of the most sobering prognoses in oncology. For the small fraction of patients who present with resectable disease, surgery offers the only hope for a cure. But even after a successful resection, the risk of recurrence is incredibly high, making effective adjuvant therapy a critical component of care. For decades, the question of "what to do after surgery" has been one of the most contentious debates in GI oncology, pitting aggressive systemic chemotherapy against the potential local control benefit of radiation.Today, we're going to trace this evolution. We’ll dissect the landmark trials that both built up and tore down the role of adjuvant radiation, and follow the rise of modern chemotherapy from single agents to the powerhouse regimens that are finally moving the survival needle.