Intraoperative Radiation Therapy in Resected Pancreatic Carcinoma: Long-Term Analysis

Journal Article · Sat Mar 15 04:00:00 EDT 2008 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2007.07.2346· OSTI ID:21039830

Valentini, Vincenzo ^[1]; Morganti, Alessio G ^[1]; Macchia, Gabriella ^[2]; Mantini, Giovanna; Mattiucci, Gian C ^[1]; Brizi, M Gabriella ^[3]; Alfieri, Sergio; Bossola, Maurizio; Pacelli, Fabio ^[4]; Sofo, Luigi ^[5]; Doglietto, Giovanbattista ^[4]; Cellini, Numa ^[1]

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1. Department of Radiotherapy, Policlinico Universitario 'A. Gemelli', Catholic University, Rome (Italy)
2. Department of Radiotherapy, 'John Paul II' Center for High Technology Research and Education in Biomedical Sciences, Catholic University, Campobasso (Italy)
3. Department of Radiology, Policlinico Universitario 'A. Gemelli', Catholic University, Rome (Italy)
4. Department of Surgery, Policlinico Universitario 'A. Gemelli', Catholic University, Rome (Italy)
5. Department of Surgery, 'John Paul II' Center for High Technology Research and Education in Biomedical Sciences, Catholic University, Campobasso (Italy)

Purpose: The combination of external radiotherapy (RT) plus intraoperative radiotherapy (IORT) in patients with pancreatic cancer is still debated. This study presents long-term results (minimum follow-up, 102 months) for 26 patients undergoing integrated adjuvant RT (external RT + IORT). Methods and Materials: From 1990 to 1995, a total of 17 patients with pancreatic cancer underwent IORT (10 Gy) and postoperative external RT (50.4 Gy). Preoperative 'flash' RT was included for the last 9 patients. The liver and pancreatic head received 5 Gy (two 2.5-Gy fractions) the day before surgery. In the subsequent period (1996-1998), 9 patients underwent preoperative concomitant chemoradiation (39.6 Gy) with 5-fluorouracil, IORT (10 Gy), and adjuvant chemotherapy. Results: Preoperative chemoradiation was completed in all patients, whereas postoperative therapy was completed in 13 of 17 patients. All 26 patients underwent pancreatectomy (25 R0 and one R1 resections). One patient died of postoperative complications (3.8%) not related to IORT. The 9 patients undergoing concomitant chemoradiation were candidates for adjuvant chemotherapy; however, only 4 of 9 underwent adjuvant chemotherapy. At last follow-up, 4 patients (15.4%) were alive and disease free. Disease recurrence was documented in 20 patients (76.9%). Sixteen patients (61.5%) showed distant metastasis, and 5 patients (19.2%) showed local recurrence. The incidence of local recurrence in R0 patients was 4 of 25 (16.0%). The overall 5-year survival rate was 15.4%. There was significant correlation with overall survival of tumor diameter (p = 0.019). Conclusions: The incidence of local recurrence in this long follow-up series (19.2%) was definitely less than that reported in other studies of adjuvant RT ({approx}50%), suggesting a positive impact on local control of integrated adjuvant RT (IORT + external RT)

• OSTI ID: 21039830
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 70; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CARCINOMAS
CHEMOTHERAPY
LIVER
METASTASES
PANCREAS
PATIENTS
RADIOTHERAPY
SURGERY
URACILS