title: Prognostic implications of intraoperative radiotherapy for unresectable pancreatic cancer.
abstract: OBJECTIVE
  To assess the prognostic effect of intraoperative radiotherapy (IORT) in unresectable pancreatic cancer.
  
  
  METHODS
  We reviewed 198 patients with unresectable pancreatic cancer, which was found during experimental laparotomy. Liver metastasis was observed in 70 patients, peritoneal metastasis in 44, liver and peritoneal metastasis in 23 and locally advanced tumor in 61. Treatment consisted of IORT with or without postoperative chemotherapy. Overall survival (OS) and prognostic factors were evaluated for each pattern of disease spread.
  
  
  RESULTS
  IORT was performed in 120 patients, and chemotherapy was administered in 80. Sixty patients did not receive either treatment. OS in the untreated group was significantly inferior to that for IORT alone and IORT plus gemcitabine (GEM)-based chemotherapy. IORT and GEM-based chemotherapy were identified as independent prognostic factors [hazard ratio (HR) = 0.51, p < 0.001; HR = 0.43, p < 0.001]. IORT was an independent prognostic determinant for patients with peritoneal metastasis (HR = 0.24, p = 0.011) but not for those with liver metastasis (HR = 0.78, p = 0.381).
  
  
  CONCLUSIONS
  IORT followed by GEM-based chemotherapy is the recommended treatment strategy in unresectable pancreatic cancer. and IAP.
authors.affiliation: Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Nagai
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Fujii
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
authors.forename: Mitsuro
authors.initials: M
authors.lastname: Kanda
authors.forename: Tevfik T
authors.initials: TT
authors.lastname: Sahin
authors.forename: Akiyuki
authors.initials: A
authors.lastname: Kanzaki
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamada
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugimoto
authors.forename: Shuji
authors.initials: S
authors.lastname: Nomoto
authors.forename: Shin
authors.initials: S
authors.lastname: Takeda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Morita
authors.forename: Akimasa
authors.initials: A
authors.lastname: Nakao
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011379:Prognosis; D011878:Radiotherapy; D015996:Survival Rate