INTERSTITIAL HDR-BRACHYTHERAPY OF UNRESECTABLE PANCREATIC-CARCINOMA BY 3D-CT-PLANNING IN COMBINATION WITH EXTERNAL-BEAM RADIATION AND CHEMOTHERAPY - METHODOLOGY AND CLINICAL-RESULTS

Purpose: Clinical experiences in interstitial 192-iridium HDR brachyth erapy for the treatment of unresectable pancreatic carcinoma are prese nted. Brachytherapy has been used as boost irradiation in a multimodal ity treatment concept together with external radiotherapy and simultan eous chemotherapy. Practicability during clinical routine, tolerabilit y and toxicity of treatment are investigated. Patients and Methods: Ni neteen patients (9 female, 10 male, median age 67 years) with unresect able carcinoma of the pancreas have been treated with interstitial bra chytherapy. Distribution according to UICC stages showed 4, 10 and 5 p atients in stage II to IV respectively. In all cases afterloading tech nique with 192-iridium in HDR-modus was used. A total dose of 10 to 34 Gy to the reference isodose was delivered (single dose 1.88 to 5 Gy, median 2.5 Gy). Brachytherapy was followed by external radiotherapy, d elivering an additional dose of 40 to 58 Gy. Nine patients received si multaneous chemotherapy (5-fluorouracil, leucovorin). Treatment planni ng was performed based on CT scans, allowing spatial correlation of is odose curves to the patient's anatomy. Results: Median survival time w as 6 months. A trend of lower survival rates with advanced stage of di sease (median survival stage IV 4 months, stage II and III 6.5 months) was seen. Local control rate was 70%. Brachytherapy treatment was wel l tolerated, severe acute side effects were not observed. One patient developed pancreatic fistulae 4 months and 1 patient a gastric ulcer 7 months after treatment. Pain release was achieved in all patients. Co nclusions: 192-iridium HDR-brachytherapy is an effective tool in the t reatment of unresectable pancreatic carcinoma with a high rate of loca l control and a low rate of side effects and is comparable IORT or see d implantation.