title: Intra-operative radiotherapy (IORT) in pancreatic cancer: joint analysis of the ISIORT-Europe experience.
abstract: OBJECTIVE
  A joint analysis of data from five contributing centers within the ISIORT-Europe program was performed to investigate the main contributions of intra-operative radiotherapy (IORT) to the multidisciplinary treatment of pancreatic cancer.
  
  
  METHODS
  Patients with a histologic diagnosis of carcinoma of the pancreas, with an absence of distant metastases, undergoing surgery with radical intent and IORT were considered eligible for participation in this study.
  
  
  RESULTS
  From 1985 to 2006, a total of 270 patients were enrolled in the study from five European institutions. Surgery was performed in 91.5% of cases and complicated by adverse events in 59 cases. External radiotherapy (ERT) preceded surgery in 23.9% of cases. One-hundred and six patients received further ERT. After surgery + IORT, median follow-up was 96 months (range 3-180). Median local control was 15 months, 5-year local control was 23.3%. Median overall survival was 19 months, while 5-year survival was 17.7%. A significantly greater local control and survival were observed in patients undergoing preoperative radiotherapy (LC: median not reached; OS: median 30 months) compared to patients treated with postoperative ERT alone (LC: median 28 months; OS: median 22 months), and to patients submitted to IORT exclusively (LC: median 8 months; OS: median 13 months) (p < 0.0001).
  
  
  CONCLUSIONS
  From this joint analysis emerges the fact that preoperative radiotherapy increases the effects of IORT in terms of local control and overall survival. The 5-year local control of 23.3% confirms the beneficial "sterilizing" effect of IORT on the tumor bed.
authors.affiliation: Università Cattolica del Sacro Cuore, Department of Radiotherapy, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.forename: Felipe
authors.initials: F
authors.lastname: Calvo
authors.forename: Michele
authors.initials: M
authors.lastname: Reni
authors.forename: Robert
authors.initials: R
authors.lastname: Krempien
authors.forename: Felix
authors.initials: F
authors.lastname: Sedlmayer
authors.forename: Markus W
authors.initials: MW
authors.lastname: Buchler
authors.forename: Valerio
authors.initials: V
authors.lastname: Di Carlo
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Doglietto
authors.forename: Gerd
authors.initials: G
authors.lastname: Fastner
authors.forename: José L
authors.initials: JL
authors.lastname: Garcia-Sabrido
authors.forename: GianCarlo
authors.initials: G
authors.lastname: Mattiucci
authors.forename: Alessio G
authors.initials: AG
authors.lastname: Morganti
authors.forename: Paolo
authors.initials: P
authors.lastname: Passoni
authors.forename: Falk
authors.initials: F
authors.lastname: Roeder
authors.forename: Giuseppe R
authors.initials: GR
authors.lastname: D'Agostino