title: Intraoperative radiotherapy and bypass surgery for unresectable pancreatic cancer.
abstract: OBJECTIVE
  Conflicting results have been reported concerning the usefulness of radiotherapy for unresectable pancreatic cancer. We evaluated the clinical efficacy of intraoperative radiotherapy and/or external beam radiotherapy in combination with bypass surgery.
  
  
  METHODS
  Twenty-six patients with unresectable pancreatic cancer (16 in Stage II-III and 10 in Stage IV) were treated with intraoperative radiotherapy plus external beam radiotherapy (16 patients) or intraoperative radiotherapy alone (10 patients). The dose of intraoperative radiotherapy was either 25 or 30 Gy and the external beam radiotherapy dose was 31-60 Gy. The feasibility and clinical outcome were analyzed.
  
  
  RESULTS
  The median survival time for Stage II-III and Stage IV were 11.5 and 6.5 months, respectively. The difference between Stage II-III and Stage IV in survival patterns was statistically significant (P < 0.05). For Stage II-III patients, the survival curves between the groups of intraoperative radiotherapy plus external beam radiotherapy and intraoperative radiotherapy alone were not significantly different, and only performance status was a significant factor in the prognosis (P < 0.05). Gastrointestinal bleeding was noted in 8%, but did not occur in the patients treated with an external beam radiotherapy dose less than 50 Gy. Palliative radiation was successfully performed to relieve pain, jaundice and appetite-loss and to shorten the hospital stay.
  
  
  CONCLUSIONS
  The combination therapy with intraoperative radiotherapy and bypass surgery is considered to be tolerable and effective for unresectable pancreatic cancer, and also may improve the quality of life of the patients.
authors.affiliation: Department of Radiology, National Takasaki Hospital, Gunma, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Y
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Y
authors.initials: Y
authors.lastname: Nakayama
authors.forename: S
authors.initials: S
authors.lastname: Nakamoto
authors.forename: T
authors.initials: T
authors.lastname: Kusaba
authors.forename: S
authors.initials: S
authors.lastname: Kakinuma
authors.forename: Y
authors.initials: Y
authors.lastname: Sakata
authors.forename: N
authors.initials: N
authors.lastname: Mitsuhashi
authors.forename: H
authors.initials: H
authors.lastname: Niibe
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011183:Postoperative Complications; D011879:Radiotherapy Dosage; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome