Pancreatic cancer carries a dismal prognosis, with a 5-year survival rate of approximately 10%. Due to the lack of effective early screening methods, most patients present with locally advanced, vessel-involving tumors or distant metastases at diagnosis, rendering clinical management challenging. Under a multidisciplinary team (MDT) model, precision radiotherapy techniques have achieved multiple advances in recent years. Neoadjuvant or definitive stereotactic body radiotherapy (SBRT) combined with effective chemotherapy regimens can achieve high R0 resection rates and significantly prolong overall survival (OS). Magnetic resonance-guided radiotherapy (MRgRT) and stereotactic MR-guided adaptive radiotherapy (SMART) with online adaptive planning have further elevated the biological effective dose (BED) to >70 Gy while maintaining grade ≥3 toxicity rates below 3%. Clinical research has shown significant improvements in local control and delay to second-line treatment. Current challenges include defining the optimal radiotherapy window, individualizing target volumes and dose prescription, and integrating biomarker-guided immunotherapy or targeted combinations. Future efforts should establish evidence-based standardized combined radiotherapy regimens, investigate tumor microenvironment and DNA repair-related resistance mechanisms, and advance multimodal combinations with immune checkpoint inhibitors and targeted agents, to offer safer and more effective comprehensive treatment pathways for pancreatic cancer patients.