Intraoperative Radiotherapy for Patients with Carcinoma of the Pancreas

Abstract

During the period from 1978 to 1986, 106 patients were diagnosed with carcinoma of the pancreas; 30 of these patients were excluded from this study. Of the remaining 76 patients, 40 did not receive intraoperative radiotherapy (IORT) and were used as the nonrandomized control group for the 36 patients who did receive IORT after histologic confirmation of carcinoma of the pancreas. The records of 35 patients were available for review. The group receiving IORT ranged in ages from 43 to 89 years (20 males and 15 females). Seventeen patients had distant metastatic disease. The primary was located in the head of the pancreas in 32 and the body in three. No patient in this group had a curative resection. All patients were treated by a combination of biliary and gastric bypass prior to or concurrent with IORT. IORT was begun only after obtaining a histologic diagnosis and prior to the completion of any anastomosis. Necrotizing pancreatitis occurred in the treated group. There was no statistically significant difference in the survival of the nonrandomized control and treated groups.

Intraoperative radiotherapy for resectable and unresectable pancreatic carcinoma

“…The efficacy of IORT in the treatment of unresectable pancreatic cancer has been reported by several groups 6,9,. In our series, the survival rate of unresectable patients who received IORT was higher than that of unresectable patients who did not receive this treatment.…”

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

“…8,9 Intraoperative radiation therapy (IORT), the delivery of a single, large dose of irradiation at the time of surgery, was developed in order to administer higher doses of irradiation while displacing or shielding adjacent normal tissue structures from radiation exposure . 10 In pancreatic cancer, IORT has been offered for unresectable tumors to provide local tumor control and palliation of pain, [11][12][13][14][15][16] and for resectable tumors in an effort to improve local control and survival after PD. [11][12][13][14][15][16][17][18][19] Although a definitive survival benefit has not been observed, improvement of local control by IORT at the time of PD for resectable pancreatic cancer is supported by retrospective data, as well as by a prospective, randomized trial conducted at the National Cancer Institute (NCI).…”

“…10 In pancreatic cancer, IORT has been offered for unresectable tumors to provide local tumor control and palliation of pain, [11][12][13][14][15][16] and for resectable tumors in an effort to improve local control and survival after PD. [11][12][13][14][15][16][17][18][19] Although a definitive survival benefit has not been observed, improvement of local control by IORT at the time of PD for resectable pancreatic cancer is supported by retrospective data, as well as by a prospective, randomized trial conducted at the National Cancer Institute (NCI). [19][20][21] At our institution, IORT has been offered since 1986 in a dedicated operating suite located in the radiotherapy department for patients with either resectable or unresectable pancreatic cancer.…”

Adjuvant therapy for pancreatic cancer: an evolving paradigm

“…Adjuvant external beam radiation after potentially curative pancreatic resection reduces local recurrence rates but does not improve overall survival. In contrast, some studies suggest a potential survival benefit from the use of intraoperative radiation therapy (IORT) in conjunction with surgical resection, although discordant data have also been reported [18][19][20][21][22][23][24]. Intraoperative radiation therapy permits the delivery of high-dose radiation directly to areas at highest risk of local recurrence, while minimizing toxicity to adjacent normal tissues.…”