ADENOCARCINOMA OF THE BODY AND TAIL OF THE PANCREAS - IS THERE ROOM FOR ADJUVANT RADIOTHERAPY

Aims and background: Adenocarcinoma of the body and tail of the pancre as is a rare malignancy with a poor prognosis. Few long-term survivors have been reported in the literature. The role of adjuvant treatment after curative resection has not yet been assessed. This retrospective study aims to describe the patterns of failure and the survival of 10 patients treated with resection and adjuvant radiotherapy. Materials and methods: from 1982 to June 1994, 10 patients with adenocarcinoma o f the body and tail of the pancreas received adjuvant radiotherapy in our department. There were 4 females and 6 males, with a median age of 63 years (range, 45-77). The pT distribution was 2 pT1 4 pT2, 4 pT3 a nd for pN it was 7 pN0 and 3 pN1. Four patients had stage 1, 3 stage I I and 3 stage III disease. All the patients underwent a resection: dis tal pancreatectomy in 7, partial resection of the body in 1, and total pancreatectomy in 2. Gross residual disease was present in 2 cases. T hree patients received intraoperative radiotherapy up to a dose of 12- 15 Gy. Postoperative radiotherapy was given in 9 patients with a dose ranging from 40 to 50 Gy (median, 45). One patient who received intrao perative radiotherapy had np postoperative radiotherapy. In 4 patients , chemotherapy with 5-fluorouracil was given during the first week of irradiation. Results: Six patients experienced a local-regional relaps e and 3 developed metastases. The median survival was 21 months. The 5 -year overall survival was 15%. Eight patients died of progressive dis ease. One patient who presented with stage I disease was alive and fre e of disease at 24 months from diagnosis and, interestingly, one with stage III disease was alive at 111 months. No severe treatment-related complications were observed. Conclusions: As in carcinoma of the head of the pancreas, adjuvant radiotherapy should be considered as an adj uvant treatment of resected adenocarcinoma of the body and tail of the pancreas. Further evaluation is necessary to assess the role of intra operative radiotherapy.