title: Intraoperative radiotherapy for unresectable pancreatic cancer: a multi-institutional retrospective analysis of 144 patients.
abstract: OBJECTIVE
  To retrospectively analyze the results of intraoperative radiotherapy (IORT) + external beam radiotherapy (EBRT) for unresectable pancreatic cancer.
  
  
  METHODS
  The records of 144 patients treated with IORT, with or without, EBRT were reviewed. One hundred and thirteen patients (78.5%) were treated with IORT + EBRT and 114 patients (79.2%) were treated in conjunction with chemotherapy. The median doses of IORT and EBRT were 25 Gy and 45 Gy, respectively. The median follow-up of all 144 patients was 9.6 months (range, 0.5-69.7 months).
  
  
  RESULTS
  At the time of this analysis, 131 of 144 patients (91.0%) had disease recurrences. Local progression was observed in 60 patients (41.7%), and the 2-year local control (LC) rate in all patients was 44.6%. Patients treated with IORT, with or without, EBRT had significantly more favorable LC (2-year LC, 50.9%) than those treated with IORT without EBRT (p = 0.0004). The 2-year overall survival (OS) rate and the median survival time in all 144 patients were 14.7% and 10.5 months, respectively. Patients treated with chemotherapy had a significantly favorable OS than those treated without chemotherapy (p < 0.0001). On univariate analysis, chemotherapy use alone had a significant impact on OS and on multivariate analysis; chemotherapy use was a significant prognostic factor. Late gastrointestinal morbidity of National Cancer Institute-Common Terminology Criteria Grade 3 was observed in 2 patients (1.4%).
  
  
  CONCLUSIONS
  IORT + EBRT yields a relatively favorable LC rate for unresectable pancreatic cancer with low frequency of severe late toxicity, and IORT combined with chemotherapy conferred a survival benefit compared with IORT without chemotherapy.
authors.affiliation: Department of Radiology, University of the Ryukyus, Nishihara-cho, 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: Etsuyo
authors.initials: E
authors.lastname: Ogo
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: 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; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007564:Japan; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016019:Survival Analysis