Intraoperative radiotherapy for pancreatic cancer: 30-Year experience in a single institution in Japan

Keiichi Jingu, Takaya Tanabe, Kenji Nemoto, Hisanori Ariga, Rei Umezawa, Yoshihiro Ogawa, Ken Takeda, Masashi Koto, Toshiyuki Sugawara, Masaki Kubozono, Eiji Shimizu, Keiko Abe, Shogo Yamada

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)

Abstract

Purpose: To analyze retrospectively the results of intraoperative radiotherapy (IORT) with or without external beam radiotherapy (± EBRT) for localized pancreatic cancer in the past three decades and to analyze prognostic factors by multivariate analysis. Methods and Materials: Records for 322 patients with pancreatic cancer treated by IORT ± EBRT in Tohoku University Hospital between 1980 and 2009 were reviewed. One hundred ninety-two patients who had no distant organ metastases or dissemination at the time of laparotomy were enrolled in the present study. Results: Eighty-three patients underwent gross total resection (R0: 48 patients, R1: 35 patients), and 109 patients underwent only biopsy or palliative resection. Fifty-five patients underwent adjuvant EBRT, and 124 underwent adjuvant chemotherapy. The median doses of IORT and EBRT were 25 and 40 Gy, respectively. The median follow-up period was 37.5 months. At the time of the analysis, 166 patients had disease recurrence, and 35 patients had local failure. The 2-year local control (LC) and overall survival (OS) rates were 71.0% and 16.9%, respectively. Comparison of the results for each decade showed that OS was significantly improved decade by decade (2-year: 25.0% vs. 18.8% vs. 4.2%, p < 0.001). Multivariate analysis showed that degree of resection (R0-1 vs. R2, hazard ratio = 1.97, p = 0.001) and adjuvant chemotherapy (yes vs. no, hazard ratio = 1.54, p = 0.028) had significant impacts on OS. Late gastrointestinal morbidity of Common Terminology Criteria for Adverse Events version 3.0 grade 4 or 5 was observed in four patients. Conclusion: Excellent local control for pancreatic cancer with few cases of severe late toxicity was achieved by using IORT. OS of patients with pancreatic cancer treated by IORT ± EBRT improved significantly decade by decade. Multivariate analysis showed that degree of resection and adjuvant chemotherapy had significant impacts on OS.

Original languageEnglish
Pages (from-to)e507-e511
JournalInternational Journal of Radiation Oncology Biology Physics
Volume83
Issue number4
DOIs
Publication statusPublished - 2012 Jul 15

Keywords

  • 30-year experience
  • Chemoradiotherapy
  • Intraoperative radiotherapy
  • Pancreatic cancer
  • Prognostic factor

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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