Pancreatic Resection Combined With Intraoperative Radiation Therapy for Pancreatic Cancer

Abstract

ObjectiveThe objective of the study was to analyze a single center's experience in the treatment of pancreatic carcinoma with a combination of pancreatic resection and intraoperative radiation therapy (IORT). Summary Background DataPancreatic cancer is the most lethal form of gastrointestinal malignancy. Historically, it carries a 20% 1-year survival and a 5-year survival of 3% to 5%. Since 1987, patients at Thomas Jefferson University Hospital have been offered IORT in an attempt to improve their survival. MethodsThe authors reviewed all patients treated at Thomas Jefferson University Hospital with pancreatic adenocarcinoma from 1987 to 1994. From this population, 14 patients were identified who received IORT in conjunction with curative surgery. Duration of hospital stay, perioperative complications, duration of postoperative ileus, and survival were assessed by retrospective review.

RETRACTED ARTICLE: EphA2: a determinant of malignant cellular behavior and a potential therapeutic target in pancreatic adenocarcinoma

“…Owing to the highly aggressive invasion, early metastasis and nonspecific symptoms characteristic of this malignancy, 90% of patients are diagnosed with surgically unresectable disease (Farrell et al, 1997). Current chemotherapy regimes offer only marginal survival benefit, and alternative therapeutic strategies are urgently required.…”

RETRACTED ARTICLE: CEACAM6 gene silencing impairs anoikis resistance and in vivo metastatic ability of pancreatic adenocarcinoma cells

“…Pancreatic adenocarcinoma is characterized by aggressive invasion and early metastasis, such that 90% of patients have surgically unresectable advanced disease at the time of diagnosis. Even patients without overtly advanced disease often subsequently develop metastases and tumor recurrence despite apparently curative resection (Farrell et al, 1997). Anoikis resistance represents a potential target for novel antimetastatic strategies directed at preventing or slowing progression of this disease.…”

Does Intraoperative Radiation Therapy Improve Local Tumor Control in Patients Undergoing Pancreaticoduodenectomy for Pancreatic Adenocarcinoma? A Propensity Score Analysis

“…31 Importantly, the addition of IORT after PD did not increase perioperative complication rates significantly in the current series, which is consistent with the earlier experience from our institution. 22 Although late complications have been reported after IORT for pancreatic cancer, our results and other reports suggest that IORT may be delivered safely in combination with surgical resection. 24,26,28,32,[33][34][35][36][37] Selection of 38,39 These studies created a foundation for the rational delivery of IORT in humans, so it should not be surprising that clinical studies have shown these RT doses to be safe and feasible.…”

“…Prior reports from our institution have described outcomes of patients who received IORT for resectable and unresectable pancreatic cancer prior to 1995. 13,22 The current study evaluates outcomes for patients who received treatment for resectable pancreatic cancer from 1995 to 2005. As a result of physician bias for the use of IORT in more advancedstage pancreatic cancer at our institution, it was not possible to identify a comparative group of patients for use in a matched pair analysis.…”

“…27 Although some authors report a survival benefit from IORT for resectable pancreatic tumors at their institutions, the literature does not consistently support this claim, and detection of a potential small survival benefit would require a large trial. 19,22,24,26,28,29 Regardless of the absence of improved survival, the problem of locoregional control does leave open a place for radiation therapy after PD, and IORT is an effective technique to boost radiation dose around the resection bed while displacing sensitive adjacent organs. 8,10,17,30 A recent analysis of the Surveillance, Epidemiology, and End Results database revealed a survival benefit to the addition of adjuvant radiotherapy after PD, and radiation therapy remains an important component of adjuvant strategies in the United States.…”