title: Combined intraoperative radiation and perioperative chemotherapy for unresectable cancers of the pancreas.
abstract: OBJECTIVE
  To evaluate the effectiveness of combined intraoperative radiation therapy (IORT) and perioperative chemotherapy in the management of unresectable pancreatic cancer.
  
  
  METHODS
  Forty-nine patients with localized unresectable adenocarcinoma of the pancreas were treated in a multimodality program of initial IORT and perioperative chemotherapy (fluorouracil [5-FU]/leucovorin) followed by combined external-beam radiation (40 to 55 Gy) and continued chemotherapy. Patients were evaluated for toxicity, pattern of failure, and survival. The follow-up times of these patients range from a minimum of 12 months to a maximum of 62 months, with a median of 28 months.
  
  
  RESULTS
  The incidence of perioperative mortality was 0%. Early postsurgical morbidity (grade 3/4) was observed in seven of 49 patients (14%) and late treatment-related morbidity (grade 3/4) in eight of 43 patients (19%) alive beyond 6 months. Morbidity was primarily gastrointestinal (GI), with no hematologic toxicities observed. The median survival time in the total group of patients is 16 months, with a 2-year survival rate of 22% and a 4-year survival rate of 7%. Freedom from local progression of disease was achieved in 71% of patients.
  
  
  CONCLUSIONS
  The patients who undergo IORT with electrons and treated with perioperative chemotherapy (5-FU leucovorin) followed by additional external-beam radiation and chemotherapy appear to have improved survival, with few early or late complications. Dose escalation of external-beam radiation and chemotherapy may further improve local control of disease and survival of patients.
authors.affiliation: Department of Radiation Medicine, University of Kentucky, Lexington 40536-0084, USA.
authors.forename: M
authors.initials: M
authors.lastname: Mohiuddin
authors.forename: W F
authors.initials: WF
authors.lastname: Regine
authors.forename: J
authors.initials: J
authors.lastname: Stevens
authors.forename: F
authors.initials: F
authors.lastname: Rosato
authors.forename: D
authors.initials: D
authors.lastname: Barbot
authors.forename: W
authors.initials: W
authors.lastname: Biermann
authors.forename: R
authors.initials: R
authors.lastname: Cantor
mesh_terms: D000206:Actuarial Analysis; D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D011184:Postoperative Period; D015996:Survival Rate
chemical_list: D005472:Fluorouracil