Does Intraoperative Radiation Therapy Improve Local Tumor Control in Patients Undergoing Pancreaticoduodenectomy for Pancreatic Adenocarcinoma? A Propensity Score Analysis

Showalter, Timothy N.; Rao, Atul; Anné, Pramila R.; Rosato, Francis E.; Rosato, Ernest L.; Andrel, Jocelyn; Hyslop, Terry; Xu, Xiangdong; Berger, Adam C.

doi:10.1245/s10434-009-0498-1

Cited by 41 publications

(26 citation statements)

References 42 publications

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“…In general, toxicities related to IORT are limited and include colitis, gastrointestinal bleeding, epigastric discomfort and ileus [58,59]. Multiple series from select institutions, including a propensity score-matched analysis, have suggested no significant difference in perioperative complications with the use of IORT [60,61]. …”

Section: Surgical Resection and Intraoperative Therapymentioning

confidence: 99%

Treatment of Locally Advanced Pancreatic Ductal Adenocarcinoma

Loehrer¹,

Ferrone²

2016

Dig Surg

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Pancreatic ductal adenocarcinoma (PDAC) is increasingly common and a leading cause of cancer-related mortality. Surgery remains the only possibility for cure. Upwards of 40% of patients present with locally advanced PDAC (LA-PDAC), where management strategies continue to evolve. In this review, we highlight current trends in neoadjuvant chemotherapy, surgical resection, and other multimodality approaches for patients with LA-PDAC. Despite promising early results, additional work is needed to more accurately and appropriately tailor treatment for patients with LA-PDAC.

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Section: Surgical Resection and Intraoperative Therapymentioning

confidence: 99%

Treatment of Locally Advanced Pancreatic Ductal Adenocarcinoma

Loehrer¹,

Ferrone²

2016

Dig Surg

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“…Some studies have also shown an improvement in survival [165, 168, 172, 173]. 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.…”

Section: Clinical Results With Iortmentioning

confidence: 75%

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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“…We assume that IORT can control tumor progression and prolong survival [7]. Without treatment, the primary tumor may grow and metastasize rapidly, which leads to reduced survival time.…”

Section: Discussionmentioning

confidence: 99%

“…Typical IORT-related complications such as postoperative gastrointestinal ulcer and cytopenia were not observed in our study. Although late complications have been reported after IORT for pancreatic cancer, most reports have suggested that IORT can be delivered safely [7,30,31]. In view of the treatment compliance, IORT can be considered the first-line treatment strategy for unresectable pancreatic cancer, and this should be followed whenever possible by GEM-based chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Some reports have suggested that intraoperative radiotherapy (IORT) can be used for the purpose of preventing local recurrence after curative resection or as pain control for patients with an unresectable tumor [3,4,5,6,7,8,9,10,11,12]. In contrast, the influence of IORT on long-term outcome is regarded as limited, both for resectable and unresectable pancreatic cancer, and few studies have indicated a positive association between IORT and prognosis [6,7,8,9,10,11,13]. …”

Section: Introductionmentioning

confidence: 99%

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