INTRAOPERATIVE RADIATION-THERAPY ADJUVANT TO RESECTION IN THE TREATMENT OF PANCREATIC-CANCER

Background. Local recurrence is the most frequent site of failure afte r resection for pancreatic cancer. Tolerance, local control, and survi val obtained by the association of resection and intraoperative radiat ion therapy (IORT) were reported. Methods. Between Tune 1985 and March 1993, 90 resections for pancreatic cancer were performed at the autho rs' institution. For 43 patients, IORT was added to resection (Group 1 ), whereas the other 47 patients underwent resection alone (Group 2), because of either the unavailability of linear accelerator or the pati ent's refusal. In Group 1, radiation doses from 12.5 to 20 Gy, with el ectron beam energies between 6 and 12 MeV, were delivered. Extension o f the disease was similar in the two groups of patients: mean diameter of the tumor was 3.2 cm in Group 1 and 3.4 cm in Group 2; percentage of third degree stage disease (International Union Against Cancer clas sification) was 65.1% in Group 1 and 57.4% in Group 2; and tumor clear ance was incomplete in 39.5% of patients in Group 1 and in 34.0% in Gr oup 2. Results. Operative mortality and overall early postoperative co mplications were respectively 2.3% and 23.2% in Group 1 and 2.1% and 2 3.4% in Group 2. One-year, 2-year, and 3-year survival rates were resp ectively 71%, 24%, and 7% in Group 1 and 49%, 16%, and 10% in Group 2 (P was not significant). Median disease free survival was 13 months in Group 1 and 8 months in Group 2 (P was' not significant). A local rec urrence was detected in 27.0% of patients in Group 1 and in 56.4% of p atients in Group 2 (P < 0.01). Conclusions. The results suggest a bett er local control in patients with pancreatic cancer undergoing adjuvan t IORT.