Chemoradiation for resected pancreatic adenocarcinoma with or without intraoperative radiation therapy boost: Long-term outcomes

Calvo, Felipe A.; Sole, Claudio V.; Atahualpa, Freddy; Lozano, Miguel A.; Gómez-Espí, M.; Calín, Ana; García‐Alfonso, Pilar; González-Bayón, L.; Herranz, R.; García-Sabrido, J.L.

doi:10.1016/j.pan.2013.09.002

Cited by 17 publications

(13 citation statements)

References 25 publications

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“…Addition of IORT to standard treatment did not result in any increase in perioperative morbidity or late toxicity rates [165, 167–169, 173]. Stage [172, 173], R 0 resection [166], chemotherapy [170], and pre-operative treatment [168] were other important determinants of survival in these studies. A systematic review also agreed with observations from these non-randomised studies and suggested a survival benefit with IORT in resected pancreatic patients.…”

Section: Clinical Results With Iortmentioning

confidence: 92%

Intraoperative radiotherapy: review of techniques and results

Pilar¹,

Gupta²,

Laskar³

et al. 2017

ecancer

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Intraoperative radiotherapy (IORT) is a technique that involves precise delivery of a large dose of ionising radiation to the tumour or tumour bed during surgery. Direct visualisation of the tumour bed and ability to space out the normal tissues from the tumour bed allows maximisation of the dose to the tumour while minimising the dose to normal tissues. This results in an improved therapeutic ratio with IORT. Although it was introduced in the 1960s, it has seen a resurgence of popularity with the introduction of self-shielding mobile linear accelerators and low-kV IORT devices, which by eliminating the logistical issues of transport of the patient during surgery for radiotherapy or building a shielded operating room, has enabled its wider use in the community.Electrons, low-kV X-rays and HDR brachytherapy are all different methods of IORT in current clinical use. Each method has its own unique set of advantages and disadvantages, its own set of indications where one may be better suited than the other, and each requires a specific kind of expertise.IORT has demonstrated its efficacy in a wide variety of intra-abdominal tumours, recurrent colorectal cancers, recurrent gynaecological cancers, and soft-tissue tumours. Recently, it has emerged as an attractive treatment option for selected, early-stage breast cancer, owing to the ability to complete the entire course of radiotherapy during surgery. IORT has been used in a multitude of roles across these sites, for dose escalation (retroperitoneal sarcoma), EBRT dose de-escalation (paediatric tumours), as sole radiation modality (early breast cancers) and as a re-irradiation modality (recurrent rectal and gynaecological cancers).This article aims to provide a review of the rationale, techniques, and outcomes for IORT across different sites relevant to current clinical practice.

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Section: Clinical Results With Iortmentioning

confidence: 92%

Intraoperative radiotherapy: review of techniques and results

Pilar¹,

Gupta²,

Laskar³

et al. 2017

ecancer

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“…The incidences of postoperative complications were reported in 8 studies [10,22,23,25,27,32,33]. The meta-analysis showed no significant difference between the IORT and non-IORT groups (41.4 vs. 40.7%; RR, 0.95; 95% CI, 0.73-1.23, P = 0.703) (Fig.…”

Section: Postoperative Complications and Operation-related Mortalitymentioning

confidence: 98%

“…Fifteen independent eligible studies [10,14,15,[22][23][24][25][26][27][28][29][30][31][32][33] were included in the analysis, these studies included 834 patients who underwent pancreatic resection with IORT (n = 401) or without IORT (n = 433). The studies were published between January 1971 and February 2019.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Eight studies [10,22,24,25,29,[31][32][33] investigated the association between IORT and postoperative LR. The pooled data showed a significantly reduced risk of LR associated with IORT (RR, 0.7; 95% CI, 0.51-0.97; P = 0.03) (Fig.…”

Section: Local Recurrencementioning

confidence: 99%

“…The second and third commonest complications were delayed gastric emptying (7.4%) and abdominal infections (6.5%). Seven studies [10,14,22,23,25,27,32] reported incidences of overall mortality. The meta-analysis indicated no significant difference in mortality (4.3% vs. 4.0%) between the IORT and non-IORT groups (RR, 1.07; 95% CI, 0.44-2.63) (Fig.…”

Section: Postoperative Complications and Operation-related Mortalitymentioning

confidence: 99%

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The role of intraoperative radiation therapy in resectable pancreatic cancer: a systematic review and meta-analysis

et al. 2020

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Purpose: Several studies investigating the role of intraoperative radiotherapy (IORT) in the treatment of resectable pancreatic cancer (PC) have been published; however, their results remain inconsistent. By conducting a systematic review and meta-analysis, this study aimed to compare clinical outcomes in patients with resectable PC who underwent surgery with or without IORT. Methods and materials:The MEDLINE/PubMed, EMBASE, and Cochrane Library databases were searched to identify relevant studies published up to February 28, 2019. The main outcome measures included median survival time (MST), local recurrence (LR), postoperative complications, and operation-related mortality. Pooled effect estimates were obtained by performing a random-effects meta-analysis. Results: A total of 1095 studies were screened for inclusion, of which 15 studies with 834 patients were included in the meta-analysis. Overall, 401 patients underwent pancreatic resection with IORT and 433 underwent surgery without IORT. The pooled analysis revealed that IORT group experienced favorable overall survival (median survival rate [MSR], 1.20; 95% confidence interval [CI], 1.06-1.37, P = 0.005), compared with patients who did not receive IORT. Additionally, the pooled data showed a significantly reduced LR rate in the IORT group compared with that in the non-IORT group (relative risk [RR], 0.70; 95% CI, 0.51-0.97, P = 0.03). The incidences of postoperative complications (RR, 0.95; 95% CI, 0.73-1.23) and operation-related mortality (RR, 1.07; 95% CI, 0.44-2.63) were similar between the IORT and non-IORT groups.Conclusion: IORT significantly improved locoregional control and overall survival in patients with resectable PC, without increasing postoperative complications and operation-related mortality rates.

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