Objective To investigate the efficacy and toxic and adverse effects of high- dose hypofractionated radiotherapy in elderly patients with stage Ⅳ pancreatic cancer. Methods The clinical data of the patients with pancreatic cancer and distant metastasis who were admitted to our hospital from September 2011 to May 2015 were collected,and all the patients underwent high- dose hypofractionated helical tomotherapy. The data on efficacy and toxic and adverse effects were obtained through follow- up,and the evaluation of adverse effects was performed according to National Cancer Institute- Common Terminology Criteria for Adverse Events version 4. 02. The Kaplan- Meier method was used for survival analysis. Results A total of 33 patients older than 65 years received the high- dose hypofractionated radiotherapy.Of all the patients,30 received follow- up visits,and the follow- up rate was 91. 0%. The median survival time was 9 months,the 1- year overall survival rate was 24. 0%,and the rate of pain relief was 80. 0%( 20 /25). The treatment outcome of pancreatic lesions could be evaluated in 17 patients,among whom 4( 23. 5%) achieved partial remission,12( 70. 6%) achieved stable disease,and 1( 5. 9%) experienced progression. As for toxic and adverse effects,the incidence rate of grade 3 hematologic toxicity was 6. 7%( 2 /30),and no patients experienced grade > 2 upper gastrointestinal reactions. Conclusion In elderly patients with stage IV pancreatic cancer,high- dose hypofractionated radiotherapy has tolerable toxic and adverse effects and can relieve cancer pain and prolong survival time.