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Title: Survival after attempted surgical resection and intraoperative radiation therapy for pancreatic and periampullary adenocarcinoma

Abstract

Purpose: To evaluate a single institution's experience with intraoperative radiation therapy (IORT) in combination with attempted surgical resection for pancreatic and periampullary adenocarcinoma. Methods and Materials: From May 1986 until June 2001, 77 patients at LDS Hospital underwent attempted surgical resection and IORT for pancreatic or periampullary adenocarcinoma. A potentially curative resection was defined as surgery with negative or microscopic positive margins. No patients had metastatic disease at the time of surgery and IORT. Forty-four patients with tumors located in the pancreas and 9 patients with periampullary tumors underwent potentially curative surgical resection and IORT. Twenty-four patients had pancreatic tumors deemed unresectable and underwent surgical bypass and IORT. Actuarial survival was calculated from the date of IORT until last follow-up or death by use of the Kaplan-Meier method. Results: Patients undergoing a potentially curative resection and IORT for periampullary adenocarcinoma had a median survival of 167 months and a 56% 5-year actuarial survival, compared with a median survival of 16 months and a 19% 5-year actuarial survival for patients undergoing the same treatment for pancreatic adenocarcinoma (p = 0.03). Patients with unresectable disease who underwent bypass and IORT had a median survival of 11 months and a 0% 3-year survival,more » significantly worse than patients able to undergo surgical resection and IORT (p = 0.0002). The operative mortality for all patients undergoing potentially curative resection and IORT was 3.7%. Conclusions: Intraoperative radiation therapy is well tolerated and does not increase the morbidity or mortality of potentially curative surgical resection for pancreatic or periampullary adenocarcinoma. Patients with periampullary adenocarcinoma have a better prognosis than those with pancreatic adenocarcinoma, and patients with unresectable pancreatic disease fared worse.« less

Authors:
 [1];  [2];  [3];  [4];  [4]
  1. Department of Radiation Oncology, Tulane Cancer Center, New Orleans, LA (United States)
  2. Department of Radiation Oncology, LDS Hospital, Salt Lake City, UT (United States). E-mail: ldwsause@ihc.com
  3. Department of Radiation Oncology, University of Utah/Hunstman Cancer Institute, Salt Lake City, UT (United States)
  4. Department of Surgery, LDS Hospital, Salt Lake City, UT (United States)
Publication Date:
OSTI Identifier:
20706249
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 63; Journal Issue: 4; Other Information: DOI: 10.1016/j.ijrobp.2005.03.036; PII: S0360-3016(05)00567-5; Copyright (c) 2005 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BYPASSES; CARCINOMAS; DISEASE INCIDENCE; METASTASES; MORTALITY; PANCREAS; PATIENTS; RADIOTHERAPY; SURGERY

Citation Formats

O'Connor, John K., Sause, William T., Hazard, Lisa J., Belnap, Legrande P., and Noyes, R. Dirk. Survival after attempted surgical resection and intraoperative radiation therapy for pancreatic and periampullary adenocarcinoma. United States: N. p., 2005. Web. doi:10.1016/j.ijrobp.2005.03.036.
O'Connor, John K., Sause, William T., Hazard, Lisa J., Belnap, Legrande P., & Noyes, R. Dirk. Survival after attempted surgical resection and intraoperative radiation therapy for pancreatic and periampullary adenocarcinoma. United States. doi:10.1016/j.ijrobp.2005.03.036.
O'Connor, John K., Sause, William T., Hazard, Lisa J., Belnap, Legrande P., and Noyes, R. Dirk. Tue . "Survival after attempted surgical resection and intraoperative radiation therapy for pancreatic and periampullary adenocarcinoma". United States. doi:10.1016/j.ijrobp.2005.03.036.
@article{osti_20706249,
title = {Survival after attempted surgical resection and intraoperative radiation therapy for pancreatic and periampullary adenocarcinoma},
author = {O'Connor, John K. and Sause, William T. and Hazard, Lisa J. and Belnap, Legrande P. and Noyes, R. Dirk},
abstractNote = {Purpose: To evaluate a single institution's experience with intraoperative radiation therapy (IORT) in combination with attempted surgical resection for pancreatic and periampullary adenocarcinoma. Methods and Materials: From May 1986 until June 2001, 77 patients at LDS Hospital underwent attempted surgical resection and IORT for pancreatic or periampullary adenocarcinoma. A potentially curative resection was defined as surgery with negative or microscopic positive margins. No patients had metastatic disease at the time of surgery and IORT. Forty-four patients with tumors located in the pancreas and 9 patients with periampullary tumors underwent potentially curative surgical resection and IORT. Twenty-four patients had pancreatic tumors deemed unresectable and underwent surgical bypass and IORT. Actuarial survival was calculated from the date of IORT until last follow-up or death by use of the Kaplan-Meier method. Results: Patients undergoing a potentially curative resection and IORT for periampullary adenocarcinoma had a median survival of 167 months and a 56% 5-year actuarial survival, compared with a median survival of 16 months and a 19% 5-year actuarial survival for patients undergoing the same treatment for pancreatic adenocarcinoma (p = 0.03). Patients with unresectable disease who underwent bypass and IORT had a median survival of 11 months and a 0% 3-year survival, significantly worse than patients able to undergo surgical resection and IORT (p = 0.0002). The operative mortality for all patients undergoing potentially curative resection and IORT was 3.7%. Conclusions: Intraoperative radiation therapy is well tolerated and does not increase the morbidity or mortality of potentially curative surgical resection for pancreatic or periampullary adenocarcinoma. Patients with periampullary adenocarcinoma have a better prognosis than those with pancreatic adenocarcinoma, and patients with unresectable pancreatic disease fared worse.},
doi = {10.1016/j.ijrobp.2005.03.036},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 63,
place = {United States},
year = {Tue Nov 15 00:00:00 EST 2005},
month = {Tue Nov 15 00:00:00 EST 2005}
}