Abstract: Objective To explore the efficacy and side effects of 5-filuorouracil combined hypofractionated image-guided three dimensional conformal intensity modulated radiation therapy （3D-IMRT） for locally advanced pancreatic carcinoma. MethodsFrom June 2011 to December 2014， a total of 37 patients with locally advanced pancreatic carcinoma proved by histopathology were enrolled in this study. Patients were treated by image-guided 3D-IMRT （radiation dose was 48-49.6 Gy in 16 fractions） and 5-filuorouracil（a dose of 350 mg／m2，d1-d5，weekly）. The treatment efficacy and side effects was observed and all patients were followed-up. Results All patients completed 3D-IMRT. There was 5 patients got CR, 14 got PR, 14 got SD and 4 got SD. The response rate was 51.4％（19/37）， and clinical benefit response rate was 56.8％（21/37）. During the treatment， grade 3 hematologic toxicities occurred in 7 patients， serious biliary obstruction occurred in 1 patient， gastroduodenal ulcer occurred in 2 patients. The 1- and 2-year distance metastasis free survival were 36.0％ and 4.8％. The 1- and 2-year overall survival rates were 51.3％ and 11.6％. At the end date of the follow-up， 13 patients got local recurrence， 26 patients had distant metastasis. Conclusion 5-filuorouracil combined hypofractionated image-guided 3D-IMRT is effective and well-tolerated for patients with locally advanced pancreatic carcinoma.