Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지

Intraoperative Radiation Therapy for Unresectable Pancreatic Cancer

절제 불가능한 췌장암에서 수술중 방사선치료의 적용

  • Lee, Nam-Kwon (Department of Radiation Oncology, Korea University College of Medicine) ;
  • Kim, Chul-Yong (Department of Radiation Oncology, Korea University College of Medicine) ;
  • Park, Young-Je (Department of Radiation Oncology, Korea University College of Medicine) ;
  • Lee, Suk (Department of Radiation Oncology, Korea University College of Medicine)
  • 이남권 (고려대학교 의과대학 방사선종양학교실) ;
  • 김철용 (고려대학교 의과대학 방사선종양학교실) ;
  • 박영제 (고려대학교 의과대학 방사선종양학교실) ;
  • 이석 (고려대학교 의과대학 방사선종양학교실)
  • Published : 2010.12.31
⟨ Previous Next ⟩

Abstract

Purpose: We wanted to evaluate the clinical effectiveness of intraoperative radiation therapy (IORT) in combination with external beam radiation therapy (EBRT) for treating unresectable or metastatic pancreatic cancer. Methods: From August 1993 to July 2007, 28 patients with unresectable or metastatic pancreatic cancer received IORT (median: 20 Gy) combined with or without EBRT (median: 50.4 Gy). Eighteen patients were treated with IORT followed by EBRT, and 10 patients were treated by IORT alone. Eighteen patients underwent explolaparotomy and 10 patients underwent bypass surgery. Results: The 1-year overall survival rate (OS) and the median survival time of all 28 patients were 21.4% and 7.5 months, respectively. The 1-year OS and median survival time for the clinical stage III patients were 33.3% and 10.2 months, respectively, and they were 7.7% and 5.1 months for the clinical stage IV patients, respectively (p=0.007). Univariate analyses revealed that the stage, chemotherapy and tumor volume were the significant prognostic factors for OS. The patients treated with IORT combined with EBRT had a more favorable 1-year local control rate than that of those patients treated with IORT alone (88.9% vs. 50.0, respectively, p=0.009). But the significant improvement in local control did not translate into a survival benefit. The addition of EBRT was an independent prognostic factor for improving the local control rate. The operative mortality was 0%. Conclusion: IORT combined with EBRT is considered to be effective in achieving local control and palliation for patients with unresectable or metastatic pancreatic cancer. Further, IORT seems to be safe and it does not increase the mortality or the incidence of surgical wound infection.

Keywords

References

  1. Ministry for Heath, Welfare and Family Affairs. Annual Report of cancer incidence (2007) and survival (1993-2007) in Korea. 2009.
  2. Bilimoria KY, Bentrem DJ, Ko CY, et al. Validation of the 6th edition AJCC Pancreatic Cancer Staging System: report from the National Cancer Database. Cancer 2007;110: 738-744. https://doi.org/10.1002/cncr.22852
  3. Evans D, Abbruzzese J, Willett C. Cancer of the pancreas. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2001.
  4. Willett CG, Czito BG, Bendell JC. Cancer of the Pancreas. In: Perez CA, Brady LW, editors. Principles and Practice of Radiation oncology. 5th ed. Philadelphia, PA: Lippincott Co.; 2009.1336-1346.
  5. Kruse EJ. Palliation in pancreatic cancer. Surg Clin North Am 2010;90:355-364. https://doi.org/10.1016/j.suc.2009.12.004
  6. Haslam JB, Cavanaugh PJ, Stroup SL. Radiation therapy in the treatment of irresectable adenocarcinoma of the pancreas. Cancer 1973;32:1341-1345. https://doi.org/10.1002/1097-0142(197312)32:6<1341::AID-CNCR2820320609>3.0.CO;2-A
  7. Minsky BD, Hilaris B, Fuks Z. The role of radiation therapy in the control of pain from pancreatic carcinoma. J Pain Symptom Manage 1988;3:199-205. https://doi.org/10.1016/0885-3924(88)90031-0
  8. Ryu MR, Yoon SC, Kim YS, Chung SM. The results of palliative radiation therapy in patients with unresectable advanced pancreatic cancer. J Korean Soc Ther Radiol Oncol 2006;24:243-247.
  9. Ruano-Ravina A, Almazan Ortega R, Guedea F. Intraoperative radiotherapy in pancreatic cancer: a systematic review. Radiother Oncol 2008;87:318-325. https://doi.org/10.1016/j.radonc.2007.12.002
  10. Sener SF, Fremgen A, Menck HR, Winchester DP. Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985-1995, using the National Cancer Database. J Am Coll Surg 1999;189:1-7. https://doi.org/10.1016/S1072-7515(99)00075-7
  11. Moertel CG, Childs DS Jr, Reitemeier RJ, Colby MY Jr, Holbrook MA. Combined 5-fluorouracil and supervoltage radiation therapy of locally unresectable gastrointestinal cancer. Lancet 1969;2:865-867.
  12. Moertel CG, Frytak S, Hahn RG, et al. Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads＋5-fluorouracil), and high dose radiation ＋5-fluorouracil: The Gastrointestinal Tumor Study Group. Cancer 1981;48:1705-1710. https://doi.org/10.1002/1097-0142(19811015)48:8<1705::AID-CNCR2820480803>3.0.CO;2-4
  13. Li CP, Chao Y, Chi KH, et al. Concurrent chemoradiotherapy treatment of locally advanced pancreatic cancer: gemcitabine versus 5-fluorouracil, a randomized controlled study. Int J Radiat Oncol Biol Phys 2003;57:98-104. https://doi.org/10.1016/S0360-3016(03)00435-8
  14. Kim TY. Chemotherapy for advanced pancreatic cancer. Korean J Hepatobiliary Pancreat Surg 2004;8:147-151.
  15. Chauffert B, Mornex F, Bonnetain F, et al. Phase III trial comparing intensive induction chemoradiotherapy (60 Gy, infusional 5-FU and intermittent cisplatin) followed by maintenance gemcitabine with gemcitabine alone for locally advanced unresectable pancreatic cancer. Definitive results of the 2000-01 FFCD/SFRO study. Ann Oncol 2008;19: 1592-1599. https://doi.org/10.1093/annonc/mdn281
  16. Loehrer PJ, Powell ME, Cardenes HR, et al. A randomized phase III study of gemcitabine in combination with radiation therapy versus gemcitabine alone in patients with localized, unresectable pancreatic cancer: E4201. J Clin Oncol 2008:26 (Suppl; abstr 4506)
  17. Fowler JF, Tome WA, Fenwick JD, Mehta MP. A challenge to traditional radiation oncology. Int J Radiat Oncol Biol Phys 2004;60:1241-1256. https://doi.org/10.1016/j.ijrobp.2004.07.691
  18. Sindelar WF, Kinsella TJ. Normal tissue tolerance to intraoperative radiotherapy. Surg Oncol Clin N Am 2003;12: 925-942. https://doi.org/10.1016/S1055-3207(03)00087-5
  19. Willett CG, Czito BG, Bendell JC, Ryan DP. Locally advanced pancreatic cancer. J Clin Oncol 2005;23:4538-4544. https://doi.org/10.1200/JCO.2005.23.911
  20. Mohiuddin M, Regine WF, Stevens J, et al. Combined intraoperative radiation and perioperative chemotherapy for unresectable cancers of the pancreas. J Clin Oncol 1995;13:2764-2768. https://doi.org/10.1200/JCO.1995.13.11.2764
  21. Ogawa K, Karasawa K, Ito Y, et al. Intraoperative radiotherapy for unresectable pancreatic cancer: a multi-institutional retrospective analysis of 144 patients. Int J Radiat Oncol Biol Phys 2010. [Epub ahead of print].
  22. Bruera E, Hui D. Integrating supportive and palliative care in the trajectory of cancer: establishing goals and models of care. J Clin Oncol 2010;28:4013-4017. https://doi.org/10.1200/JCO.2010.29.5618
  23. World Health Organization. National Cancer Control Programmes: policies and managerial guidelines. http://www. who.int/cancer/palliative/definition/en/.