title: Intraoperative radiotherapy for resected pancreatic cancer: a multi-institutional retrospective analysis of 210 patients.
abstract: OBJECTIVE
  To retrospectively analyze the results of intraoperative radiotherapy (IORT) with or without external beam radiotherapy (EBRT) for resected pancreatic cancer.
  
  
  METHODS
  The records of 210 patients treated with gross complete resection (R0: 147 patients; R1: 63 patients) and IORT with or without EBRT were reviewed. One hundred forty-seven patients (70.0%) were treated without EBRT and 114 patients (54.3%) were treated in conjunction with chemotherapy. The median doses of IORT and EBRT were 25 Gy (range, 20-30 Gy) and 45 Gy (range, 20-60Gy), respectively. The median follow-up of the surviving 62 patients was 26.3 months (range, 2.7-90.5 months).
  
  
  RESULTS
  At the time of this analysis, 150 of 210 patients (71.4%) had disease recurrences. Local failure was observed in 31 patients (14.8%), and the 2-year local control rate in all patients was 83.7%. The median survival time and the 2-year actuarial overall survival (OS) in all 210 patients were 19.1 months and 42.1%, respectively. Patients treated with IORT and chemotherapy had a significantly more favorable OS than those treated with IORT alone (p = 0.0011). On univariate analysis, chemotherapy use, degree of resection, carbohydrate antigen 19-9, and pathological N stage had a significant impact on OS and on multivariate analysis; these four factors were significant prognostic factors. Late gastrointestinal morbidity of NCI-CTC Grade 4 was observed in 7 patients (3.3%).
  
  
  CONCLUSIONS
  IORT yields an excellent local control rate for resected pancreatic cancer with few frequencies of severe late toxicity, and IORT combined with chemotherapy confers a survival benefit compared with that of IORT alone.
authors.affiliation: Department of Radiology, University of the Ryukyus, Okinawa, Japan. kogawa@med.u-ryukyu.ac.jp
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ogawa
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Karasawa
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ito
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Keiichi
authors.initials: K
authors.lastname: Jingu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Onishi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Aoki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Wada
authors.forename: Masaki
authors.initials: M
authors.lastname: Kokubo
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Etoh
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kazumoto
authors.forename: Makoto
authors.initials: M
authors.lastname: Takayama
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Negoro
authors.forename: Kenji
authors.initials: K
authors.lastname: Nemoto
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Nishimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018395:CA-19-9 Antigen / Q000097:blood; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents; D018395:CA-19-9 Antigen