title: Intraoperative radiotherapy for pancreatic cancer: 30-year experience in a single institution in Japan.
abstract: OBJECTIVE
  To analyze retrospectively the results of intraoperative radiotherapy (IORT) with or without external beam radiotherapy (± EBRT) for localized pancreatic cancer in the past three decades and to analyze prognostic factors by multivariate analysis.
  
  
  METHODS
  Records for 322 patients with pancreatic cancer treated by IORT ± EBRT in Tohoku University Hospital between 1980 and 2009 were reviewed. One hundred ninety-two patients who had no distant organ metastases or dissemination at the time of laparotomy were enrolled in the present study.
  
  
  RESULTS
  Eighty-three patients underwent gross total resection (R0: 48 patients, R1: 35 patients), and 109 patients underwent only biopsy or palliative resection. Fifty-five patients underwent adjuvant EBRT, and 124 underwent adjuvant chemotherapy. The median doses of IORT and EBRT were 25 and 40 Gy, respectively. The median follow-up period was 37.5 months. At the time of the analysis, 166 patients had disease recurrence, and 35 patients had local failure. The 2-year local control (LC) and overall survival (OS) rates were 71.0% and 16.9%, respectively. Comparison of the results for each decade showed that OS was significantly improved decade by decade (2-year: 25.0% vs. 18.8% vs. 4.2%, p < 0.001). Multivariate analysis showed that degree of resection (R0-1 vs. R2, hazard ratio = 1.97, p = 0.001) and adjuvant chemotherapy (yes vs. no, hazard ratio = 1.54, p = 0.028) had significant impacts on OS. Late gastrointestinal morbidity of Common Terminology Criteria for Adverse Events version 3.0 grade 4 or 5 was observed in four patients.
  
  
  CONCLUSIONS
  Excellent local control for pancreatic cancer with few cases of severe late toxicity was achieved by using IORT. OS of patients with pancreatic cancer treated by IORT ± EBRT improved significantly decade by decade. Multivariate analysis showed that degree of resection and adjuvant chemotherapy had significant impacts on OS.
authors.affiliation: Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan. kjingu-jr@rad.med.tohoku.ac.jp
authors.forename: Keiichi
authors.initials: K
authors.lastname: Jingu
authors.forename: Takaya
authors.initials: T
authors.lastname: Tanabe
authors.forename: Kenji
authors.initials: K
authors.lastname: Nemoto
authors.forename: Hisanori
authors.initials: H
authors.lastname: Ariga
authors.forename: Rei
authors.initials: R
authors.lastname: Umezawa
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Ken
authors.initials: K
authors.lastname: Takeda
authors.forename: Masashi
authors.initials: M
authors.lastname: Koto
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Sugawara
authors.forename: Masaki
authors.initials: M
authors.lastname: Kubozono
authors.forename: Eiji
authors.initials: E
authors.lastname: Shimizu
authors.forename: Keiko
authors.initials: K
authors.lastname: Abe
authors.forename: Shogo
authors.initials: S
authors.lastname: Yamada
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods* / Q000401:mortality; D007564:Japan; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors