title: Effect on local control and survival of electron beam intraoperative irradiation for resectable pancreatic adenocarcinoma.
abstract: OBJECTIVE
  To assess the impact on local control and survival of intraoperative radiotherapy (IORT) in resectable pancreatic adenocarcinoma.
  
  
  METHODS
  The outcome of 127 patients surgically treated with curative intent combined with IORT was compared with the therapeutic results of 76 patients treated with surgery as exclusive treatment.
  
  
  RESULTS
  Operative mortality and morbidity were similar in IORT and no-IORT patients. In 49 patients with locally limited disease (Stage I-II; LLD), IORT (n = 30) reduced the local failure rate and significantly prolonged time to local failure (TTLF), time to failure (TTF), and overall survival (OS) with respect to surgery alone (n = 19). The multivariate analyses, stratifying patients by age, tumor grade, resection margins, chemotherapy, and external-beam radiotherapy use, confirmed the independent impact of IORT on outcome. In patients with locally advanced disease (Stage III-IVA; LAD), IORT had an impact on local failure rate and on TTLF when combined with beam energies of greater than 6 MeV, whereas no effect on TTF and OS was observed.
  
  
  CONCLUSIONS
  IORT did not increase operative mortality and morbidity and achieved a significant improvement in local control and outcome in patients with LLD. In patients with LAD, beam energies greater than 6 MeV prolonged TTLF.
authors.affiliation: Department of Radiochemotherapy, San Raffaele H. Scientific Institute, Milan, Italy. reni.michele@hsr.it
authors.forename: M
authors.initials: M
authors.lastname: Reni
authors.forename: M G
authors.initials: MG
authors.lastname: Panucci
authors.forename: A J
authors.initials: AJ
authors.lastname: Ferreri
authors.forename: G
authors.initials: G
authors.lastname: Balzano
authors.forename: P
authors.initials: P
authors.lastname: Passoni
authors.forename: G M
authors.initials: GM
authors.lastname: Cattaneo
authors.forename: S
authors.initials: S
authors.lastname: Cordio
authors.forename: U
authors.initials: U
authors.lastname: Scaglietti
authors.forename: A
authors.initials: A
authors.lastname: Zerbi
authors.forename: G L
authors.initials: GL
authors.lastname: Ceresoli
authors.forename: C
authors.initials: C
authors.lastname: Fiorino
authors.forename: R
authors.initials: R
authors.lastname: Calandrino
authors.forename: C
authors.initials: C
authors.lastname: Staudacher
authors.forename: E
authors.initials: E
authors.lastname: Villa
authors.forename: V
authors.initials: V
authors.lastname: Di Carlo
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004583:Electrons; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome