INTRAOPERATIVE RADIOTHERAPY IN RESECTED PANCREATIC-CANCER - FEASIBILITY AND RESULTS

Background and purpose: To evaluate the impact of intraoperative radio therapy (IORT) combined with postoperative external beam irradiation i n patients with pancreatic cancer treated with curative surgical resec tion. Materials and methods: From January 1986 to April 1995 25 patien ts (11 male and 14 female, median age 61 years) underwent a curative r esection with IORT for pancreatic adenocarcinoma. The tumour was locat ed in the head of the pancreatic gland in 22 patients, in the body in two patients and in the tail in one patient. The pathological stage wa s pT1 in nine patients, pT2 in nine patients, pT3 in seven patients, p NO in 14 patients and pN1 in 11 patients. All the patients were pM0. A pancreaticoduodenectomy was performed in 22 patients, a distal pancre atectomy was performed in two patients and a total pancreatectomy was performed in one patient. The resection was considered to be complete in 20 patients. One patient had microscopic residual disease and gross residual disease was present in four patients. IORT using electrons w ith a median energy of 12 MeV was performed in all the patients with d oses ranging from 12 to 25 Gy. Postoperative EBRT was delivered to 20 patients (median dose 44 Gy). Concurrent chemotherapy with 5-fluoroura cil was given to seven patients. Results: The overall survival was 56% at 1 year, 20% at 2 years and 10% at 5 years. Nine local failures wer e observed. Twelve patients developed metastases without local recurre nce. Twenty patients died from tumour progression and two patients die d from early postoperative complications. Three patients are still ali ve; two patients in complete response at 17 and 94 months and one pati ent with hepatic metastases at 13 months. Conclusion: IORT after compl ete resection combined with postoperative external beam irradiation is feasible and well tolerated in patients with pancreatic adenocarcinom a. (C) 1997 Elsevier Science Ireland Ltd.