title: [Multimodal treatment of unresectable pancreatic cancer including intra-operative radiotherapy].
abstract: A multimodal treatment was consisted of intraoperative radiation, external radiation, by-pass operation, chemotherapy and total parenteral nutrition if necessary to cover decreased oral-intake. Thirty-three cases were subjected to this therapy for 6 years. The stage of the tumors varied from a localized tumor in the pancreas to a huge tumor with multiple metastases, though the latter abandoned recently to be contraindication to this therapy. At laparotomy, a high energy electron beam was irradiated to the tumor with a dosage of 3,000 rad using a 20Me V Betatron. The tumor was carefully prepared in order to avoid irradiating the duodenum and stomach. Choledochojejunostomy and gastrojejunostomy were performed in almost all of patients with cancer of head of pancreas. In some patients, external radiation was added with a dosage of 3,000 rad by lineacX-ray. After radiotherapy, chemotherapy employing 5-FU or FT-207 was continued including. The survival time after this therapy was varied mainly according to the stages of the tumor. In patients with multiple metastasis to the liver or peritoneal dissemination, no remarkable effects were obtained by this therapy. On the other hand, among 14 patients with localized tumor in the pancreas, 7 survived more than one year and the mean survival time of treated patients was never shorter than that of patients who received resection of the tumor. Most of the treated patients could spend at home until their condition became critical, because by-pass operation could overcome jaundice or the duodenal stenosis and intraoperative radiation could palliate the pain of cancer of pancreas. Tumor effect of intraoperative radiation was confirmed by both of the second laparotomy for twice intraoperative radiation and laparotomy.
mesh_terms: D004359:Drug Therapy, Combination; D006801:Humans; D007430:Intraoperative Care; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*