Department of Radiation Oncology, Stanford Cancer Center, Stanford University, Stanford, CA, USA.
Radiat Oncol. 2010 Nov 8;5:105. doi: 10.1186/1748-717X-5-105.
To analyze the outcomes of patients from a single institution treated with surgery and orthovoltage intraoperative radiotherapy (IORT) for pancreatic adenocarcinoma.
We retrospectively reviewed 23 consecutive patients from 1990-2001 treated with IORT to 23 discrete sites with median and mean follow up of 6.5 and 21 months, respectively. Most tumors were located in the head of the pancreas (83%) and sites irradiated included: tumor bed (57%), vessels (26%), both the tumor bed/vessels (13%) and other (4%). The majority of patients (83%) had IORT at the time of their definitive surgery. Three patients had preoperative chemoradiation (13%). Orthovoltage X-rays (200-250 kVp) were employed via individually sized and beveled cone applicators. Additional mean clinical characteristics include: age 64 (range 41-81); tumor size 4 cm (range 1.4-11); and IORT dose 1106 cGy (range 600-1500). Post-operative external beam radiation (EBRT) or chemotherapy was given to 65% and 76% of the assessable patients, respectively. Outcomes measured were infield control (IFC), loco-regional control (LRC), distant metastasis free survival (DMFS), overall survival (OS) and treatment-related complications.
Kaplan-Meier (KM) 2-year IFC, LRC, DMFS and OS probabilities for the whole group were 83%, 61%, 26%, and 27%, respectively. Our cohort had three grade 3-5 complications associated with treatment (surgery and IORT).
Orthovoltage IORT following tumor reductive surgery is reasonably well tolerated and seems to confer in-field control in carefully selected patients. However, distant metastases remain the major problem for patients with pancreatic adenocarcinoma.
分析单中心采用手术联合术中正交放疗（IORT）治疗胰腺腺癌患者的结果。
我们回顾性分析了 1990 年至 2001 年间连续 23 例接受 IORT 治疗的患者，共 23 个离散部位，中位随访时间和平均随访时间分别为 6.5 个月和 21 个月。大多数肿瘤位于胰腺头部（83%），照射部位包括：肿瘤床（57%）、血管（26%）、肿瘤床/血管（13%）和其他部位（4%）。大多数患者（83%）在接受确定性手术时接受了 IORT。3 例患者接受了术前放化疗（13%）。采用单独大小和斜角圆锥施源器给予正交 X 射线（200-250 kVp）。其他平均临床特征包括：年龄 64 岁（范围 41-81 岁）；肿瘤大小 4 cm（范围 1.4-11）；IORT 剂量 1106 cGy（范围 600-1500）。可评估患者中分别有 65%和 76%接受了术后外照射放疗（EBRT）或化疗。测量的结果包括场内控制（IFC）、局部区域控制（LRC）、无远处转移生存（DMFS）、总生存（OS）和治疗相关并发症。
全组患者的 Kaplan-Meier（KM）2 年 IFC、LRC、DMFS 和 OS 概率分别为 83%、61%、26%和 27%。我们的队列中有 3 例与治疗相关的 3-5 级并发症（手术和 IORT）。
肿瘤减瘤手术后进行正交 IORT 是可以合理耐受的，并且似乎可以在经过精心选择的患者中提供场内控制。然而，远处转移仍然是胰腺腺癌患者的主要问题。
