[Intraoperative radiation therapy (IORT) of adenocarcinoma of the pancreas].
Fifty-four patients were given intraoperative radiation therapy (IORT) for adenocarcinoma of the pancreas between April, 1980 and August, 1987 at Aichi Cancer Center Hospital. Thirty-five of these patients with well-advanced cancer underwent palliative IORT of their main primary lesions which could not be resected. Twenty (or 57%) of them had liver and/or peritoneal metastases. Electron irradiation at doses of 12 Gy (1 patient), 15 Gy, 20 Gy, 22 Gy, 22.5 Gy, 25 Gy and 30 Gy was given to these patients in single doses. Gastric and/or biliary bypasses were performed in 27 (77%) of them following IORT. Twenty (80%) of the 25 patients in this group who had intractable back pain before this treatment achieved relief of pain within one week postoperatively. The median survival for this group of 35 unresectable cases was 5.3months (range 0.5-28.6 months). The remaining 19 patients underwent pancreatectomy and received adjuvant IORT to the bed of the pancreas. Two of the patients in this group had liver metastases and one patient had peritoneal seeding. All of the visible metastatic lesions were removed by local excision in these three patients. Posterior surgical margins were cancer-positive in 8 patients, suspicious in 6 and negative in 5. IORT doses were 20 Gy (7 patients), 25 Gy and 30 Gy. Median survival for this group of 19 resectable cases was 9.4 months, including 10 patients who remain alive at the time of this report (August 15, 1987). The longest survival has been 6 years 10 months in one patient after absolute non-curative distal pancreatectomy followed by 20 Gy of IORT for cancer of the body of the pancreas with a microscopically proven cancer-positive posterior surgical margin. The other nine are alive at 5 years 10 months, 2 years 4 months, 1 year 5 months, 1 year, and within one year (5 patients), respectively. Survival rates were compared between one group of 41 patients operated on in the 5 years before we began IORT and another group of 70 patients operated on after IORT introduction. The latter group included 16 patients who did not receive IORT for various reasons. The background factors were rather worse in the latter group, but both the survival rates and the staying-home survival rates were significantly better (p less than 0.05). One-year survival rates were 7% in the before-IORT period and 26% in the after-IORT period. One-year staying-home survival rates were 2% and 18%, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)
Yasue
M
M
Dept. of Gastroenterological Surgery, Aichi Cancer Center Hospital.
D000230:Adenocarcinoma / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D006801:Humans; D007432:Intraoperative Period; D010190:Pancreatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies