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Objective To evaluate the efficacy and adverse effects of low doses gemcitabine chemotherapy combined with synchronous high-low oxygen radiotherapy in patients with locally advanced pancreatic cancer.Methods Fifty-six patients with locally advanced pancreatic cancer were randomly divided into two groups by envelop method:radio-chemotherapy group or chemotherapy group.Patients in radio-chmotherapy group were treated with low doses of gemcitabine chemotherapy ( 600 mg/m2 ) combined with high-low oxygen radiotherapy synchronously,paients in chmotherapy group were treated with full doses of gemcitabine chemotherapy ( 1000 mg/m2).The short-term effect,distant metastasis rate,clinical benefit rate,survival rate and adverse events of two groups were observed.Results There was one patient achievedcomplete relief and 15 patients achieved partial relief in radio-chemotherapy group with an overall effective rate of 66.7％ (16/24) ; there were 9 patients achieved partial relief in chemotherapy group with an overall effective rate of 36.0％ (9/25),the difference between the two groups was statistically significant (X2 =4.6082,P =0.0318 ).The clinical benefit rates were 83.3 ％ ( 20/24 ) and 60％ ( 15/25 ),respectively,the difference between the two groups was not statistically significant ( P =0.070).The distant metastasis rates were 66.7％(16/24) and 72％ (18/25),respectively,the difference between the two groups was not statistically significant (P =0.6855).The 12,24 months survival rates were 62.5％ vs 32％,37.5％ vs 12％,the difference between the two groups was statistically significant ( P =0.0325,0.0380).The incidence of serious adverse events was 45.8％ and 4 0 ％ without statistical difference.Conclusions Low doses of gemcitabine chemotherapy combined with high-low oxygen radiotherapy synchronously is better than full doses of gemcitabine chemotherapy with regard to total effective rates and 12,24 months survival rates,with no obvious increase in the incidence of serious adverse events.