AIM: To determine the survival of advanced pancreatic cancer patients treated with intraoperative radiotherapy (IORT) combined with extal beam radiation therapy (EBRT) following intal drainage (cholecystojejunostomy or choledochojejunostomy).METHODS: Eighty-one patients with advanced pancreatic cancer who received IORT combined with EBRT following intal drainage (ID) between 1996 and 2001 were retrospectively analyzed. Among the 81 patients, 18underwent ID+IORT, 25 ID+IORT+EBRT (meanwhile, given 5-Fu 300 mg/m2 iv drip, 2f/w), 16 EBRT, 22 had undergone simple intal drainage. The IORT dose was 15-25Gy in a single fraction. The usual EBRT dose was 30-40Gy with a daily fraction of 1.8-2.0 Gy.RESULTS: The complete remission rate, partial remission rate of patients with backache and abdominal pain treated with ID+IORT were 55.5%, 33.3% respectively. Alleviation of pain was observed 2 or 3 wk after IORT. The median survival time (MST) of ID+IORT group was 10.7 mo. The pain remission rate of patients treated with ID+IORT+EBRT was 92%, and their MST was 12.2 mo. The MST of patients treated with EBRT and simple intal drainage was 5.1 mo and 7.0 mo, respectively. The survival curve of ID+IORT group and ID+IORT+EBRT group was significantly better than that of EBRT group (P＜0.05). The difference between the ID+IORT+EBRT group and ID group was significant (P＜0.05).CONCLUSION: IORT combined with EBRT following intal drainage can alleviate pain, improve quality of life and prolong survival time of patients with advanced pancreatic cancer.