Improved survival and local control after intraoperative radiation therapyand postoperative radiotherapy - A multivariate analysis of 46 patients undergoing surgery for pancreatic head cancer

Hypothesis: Despite aggressive approaches, locoregional tumor control and s urvival rates for patients with cancer of the pancreatic head remain disapp ointing. In the present study, we address whether intraoperative and adjuva nt radiotherapy may improve the prognosis for these patients. Design: A retrospective study. Setting: University hospital. Patients: From February 1985 to December 1995, 46 patients with an adenocar cinoma of the pancreatic head underwent pancreatic resection. The last 26 p atients also received intraoperative radiotherapy (except 5 patients) and a djuvant external beam radiation therapy. Main Outcome Measures: Demographic data, tumor characteristics, surgical pr ocedures, 5-year survival, and local control of disease were analyzed retro spectively. Results: The morbidity rate was not increased by adjuvant radiation therapy ; it was 43% in patients treated with surgery alone and 57% in patients tre ated with surgery and radiotherapy (P=.1); operative mortality was 8% (n=2) and 9% (n=2), respectively (P=.8). Overall 5-year survival and local contr ol were 13% and 48.6%, respectively. The mean+/-SD 5-year survival was 5.5% +/-5.3% (median, 10.8 months) in the surgery-alone group and 15.7%+/-8.6% ( median, 14.3 months) in the surgery plus radiotherapy group (P=.06); local control at 5 years was 29.8% +/- 16.9% and 58.4%+/-19.9%, respectively (P<. 01). Median metastasis-free survival was 8 and 9 months, respectively (P =. 52). Multivariate analysis showed that adjuvant radiotherapy was an indepen dent prognostic factor for survival (P<.01) and local control of the diseas e (P=.03). Conclusion: The present study supports the role of radiotherapy combined wi th pancreatoduodenectomy for treatment of cancer of the pancreatic head bec ause even if the improvement in overall survival is moderate, it is effecti ve in improving the local control of the tumor.