INTRAOPERATIVE AND EXTERNAL-BEAM RADIOTHE RAPY FOR PANCREATIC-CARCINOMA

Therapeutic strategies in the treatment of pancreatic carcinoma are ba sed on the high number of non-resectable cancers, the high relative ra dioresistance and the high distant metastases rate. Even in curatively resected carcinomas, a locally effective treatment modality is needed because of the risk of microscopical residual disease in the peripanc reatic tissue. The efficacy of radiotherapy is dose dependent. Based o n an analysis of published data a dose of more than 50 Gy is recommend ed, resulting in a high morbidity rate with external beam radiotherapy alone. The use of intraoperative radiotherapy allows locally restrict ed dose escalation without increased perioperative morbidity. In adjuv ant and in primary treatment, local tumor contol was improved (70-90%) . With palliative intent, pain relief was obtained rapidly in over 60% of patients and led to improved patient performance. As a result of t he high distant metastases rate, even in curatively resected carcinoma s, the overall prognosis could not be significantly improved. Further dose escalation is limited by the increasing incidence of upper gastro intestinal bleeding (20-30%).