INTEGRATED RADIOSURGICAL TREATMENT OF RESECTABLE PANCREATIC HEAD CARCINOMA

Thirty-six patients with pancreatic head carcinoma entered a protocol, but only 20 were suitable for resection and evaluation of long-term s urvival. They were nine males and 11 females, with a mean age of 64.3 years. Following surgical resection, 10 Gy was delivered to the tumor bed intraoperatively. Postoperative radiotherapy was performed 4-6 wee ks after surgery: patients were treated with 50.4 Gy (1.8 Gy/day, 5 da ys/week) to the tumor and nodal bed. Since 1991, 10 patients have also received preoperative short-course radiotherapy (5 Gy) of the liver a nd pancreas. Postoperative morbidity was 25%; two postoperative deaths were observed in patients with locally advanced neoplasms, in whom a vascular resection was also performed. Only 14 patients started postop erative radiotherapy, which was interrupted in two cases. At present, 14 patients are dead and four are alive and disease free. The local re currence rate was 11.1% and distant metastases were observed in 66.7% of cases. The median actuarial survival was 11.9 months, but it was 18 .5 months in patients with disease-free resection margins. A significa ntly better survival was also observed in patients submitted to short- course preoperative radiotherapy. These preliminary results show that intraoperative and perioperative radiotherapy is feasible and may impr ove local control of disease. Unfortunately, these results are not mat ched by a significant improvement in survival due to the high incidenc e of intraabdominal metastases. Thus, new therapeutic modalities, incl uding preoperative radiotherapy (with or without chemotherapy), should be tested.