Intraoperative radiotherapy for unresectable pancreatic cancer: a multi-institutional retrospective analysis of 144 patients.
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.
Ogawa
Kazuhiko
K
Department of Radiology, University of the Ryukyus, Nishihara-cho, Okinawa, Japan. kogawa@med.u-ryukyu.ac.jp
Karasawa
Katsuyuki
K
Ito
Yoshinori
Y
Ogawa
Yoshihiro
Y
Jingu
Keiichi
K
Onishi
Hiroshi
H
Aoki
Shinichi
S
Wada
Hitoshi
H
Kokubo
Masaki
M
Ogo
Etsuyo
E
Etoh
Hidehiro
H
Kazumoto
Tomoko
T
Takayama
Makoto
M
Nemoto
Kenji
K
Nishimura
Yasumasa
Y
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