1991 Volume 3 Issue 2 Pages 77-83
Experience with intraoperative radiation therapy (IORT) for 34 patients with advanced pancreatic cancer was reported with special reference to fractionated IORT. Eleven patients in the early period (1978-1983) were treated by IORT alone with doses of 30 down to 20Gy. In the late period (1984-1989), 23 patients were treated with followed by external irradiation, and fractionated IORT (F-IORT) was tried on seven patients with possibly resectable tumors. F-IORT had the following potential or practical advantages:(1) It suppressed metastatic potency during surgical manipulation with pre-resection IORT.(2) It exhibited some biological advantages of fractionation.(3) It reduced treatment volume with electron energy reduction in post-resection IORT. Peritoneal, or liver metastasis, or both were observed at during operations on 7 patients. Tumors were resectable in 8 patients including three who underwent F-IORT. External irradiation was completed in 11 patients. No one survived beyond 18.4 months and treatment related mortality occurred in 9 patients. Median survival and 1-year-survival rates for the patients with resectable and irresectable tumor were 12.1 and 4.9 months, and 50.0 and 7.7%, respectively (P<0.1). Those for the patients with irresectable tumor in the early (9) and the late (17) periods were 4.4 and 5.6 months, and 0.0 and 11.8%, respectively (P<0.05). A failure pattern analysis was available for 15 patients including 6 with resectable tumors and two who underwent F-IORT. Loco-regional recurrence was seen in all patients, peritoneal dissemination in 9 (60%), liver metastasis in 6 (40%), and extra-abdominal metastasis in 10 (67%). Two F-IORT patients had both peritoneal and distant failure. Though historical improvement of treatment results for patients with irresectable tumor was observed, potential advantages of F-IORT failed to appear because the disease was too advanced to reveal subtle advantages in quality and quantity. This clinical study should be applied to patients with less advanced disease.
