Intraoperatic electron beam irradiation in pancreatic cancer

Willett, Christopher G.

doi:10.2741/a379

Cited by 9 publications

(4 citation statements)

References 26 publications

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“…6 In brief, the surgeon and radiation oncologist assess the extent of disease at operation and a cylindric applicator of appropriate size (5 to 9 cm in diameter) is selected to cover the tumor comfortably within the field, usually with a 1-cm margin around the pancreatic mass. Therefore, the applicator size is a surrogate for tumor diameter, which is approximately 2 cm less than the applicator size.…”

Section: Methodsmentioning

confidence: 99%

Long-term Results of Intraoperative Electron Beam Irradiation (IOERT) for Patients With Unresectable Pancreatic Cancer

Willett¹,

Castillo²,

Shih³

et al. 2005

Annals of Surgery

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Section: Methodsmentioning

confidence: 99%

Long-term Results of Intraoperative Electron Beam Irradiation (IOERT) for Patients With Unresectable Pancreatic Cancer

Willett¹,

Castillo²,

Shih³

et al. 2005

Annals of Surgery

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“…These patients can benefit from external beam radiotherapy (EBRT) combined with chemotherapy and, according to their response, are candidates for intraoperative radiation (IORT). 3,4 A third and last subpopulation is patients with resectable tumors. These individuals may benefit from transfer to a tertiary referral center where pancreatic resection can be performed with low mortality rates.…”

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confidence: 99%

Impact of Laparoscopic Staging in the Treatment of Pancreatic Cancer

Jimenez

Warshaw²,

Rattner³

et al. 2000

Arch Surg

189

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Staging laparoscopy in patients with pancreatic cancer identifies unsuspected metastases, allows treatment selection, and helps predict survival. Design: Inception cohort. Setting: Tertiary referral center. Patients: A total of 125 consecutive patients with radiographic stage II to III pancreatic ductal adenocarcinoma who underwent staging laparoscopy with peritoneal cytologic examination between July 1994 and November 1998. Seventy-eight proximal tumors and 47 distal tumors were localized. Interventions: Based on the findings of spiral computed tomography (CT) and laparoscopy, patients were stratified into 3 groups. Group 1 patients had unsuspected metastases found at laparoscopy and were palliated without further operation. Group 2 patients had no demonstrable metastases, but CT indicated unresectability due to vessel invasion. This group underwent external beam radiation with fluorouracil chemotherapy followed in selected cases by intraoperative radiation. Patients in group 3 had no metastases or definitive vessel invasion and were resection candidates. Main Outcome Measure: Survival. Results: Staging laparoscopy revealed unsuspected metastases in 39 patients (31.2%), with 9 having positive cytologic test results as the only evidence of metastatic disease (group 1). Fifty-five patients (44.0%) had localized but unresectable carcinoma (group 2), of whom 2 (3.6%) did not tolerate treatment, 20 (36.4%) developed metastatic disease during treatment, and 21 (38.2%) received intraoperative radiation. Of 31 patients with potentially resectable tumors (group 3), resection for cure was performed in 23 (resectability rate, 74.2%). Median survival was 7.5 months for patients with metastatic disease, 10.5 months for those receiving chemoradiation, and 14.5 months for those who underwent tumor resection (P = .01 for group 2 vs group 1; PϽ.001 for group 3 vs group 1). Conclusions: Staging laparoscopy, combined with spiral CT, allowed stratification of patients into 3 treatment groups that correlated with treatment opportunity and subsequent survival. Among the 125 patients, laparoscopy obviated 39 unnecessary operations and irradiation in patients with metastatic disease not detectable by CT. Laparoscopic staging can help focus aggressive treatment on patients with pancreatic cancer who might benefit.

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“…10 In pancreatic cancer, IORT has been offered for unresectable tumors to provide local tumor control and palliation of pain, [11][12][13][14][15][16] and for resectable tumors in an effort to improve local control and survival after PD. [11][12][13][14][15][16][17][18][19] Although a definitive survival benefit has not been observed, improvement of local control by IORT at the time of PD for resectable pancreatic cancer is supported by retrospective data, as well as by a prospective, randomized trial conducted at the National Cancer Institute (NCI). [19][20][21] At our institution, IORT has been offered since 1986 in a dedicated operating suite located in the radiotherapy department for patients with either resectable or unresectable pancreatic cancer.…”

Section: Discussionmentioning

confidence: 93%