Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan.
Int J Radiat Oncol Biol Phys. 2012 Jul 15;83(4):e507-11. doi: 10.1016/j.ijrobp.2012.01.024. Epub 2012 Mar 22.
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.
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.
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.
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.
回顾性分析过去三十年中局部胰腺癌接受术中放疗（IORT）联合或不联合外部束放疗（±EBRT）的结果，并通过多因素分析分析预后因素。
回顾了 1980 年至 2009 年在东北大学医院接受 IORT±EBRT 治疗的 322 例胰腺癌患者的记录。本研究纳入了 192 例剖腹手术时无远处器官转移或播散的患者。
83 例患者行根治性全切除术（R0：48 例，R1：35 例），109 例仅行活检或姑息性切除术。55 例患者接受辅助 EBRT，124 例患者接受辅助化疗。IORT 和 EBRT 的中位剂量分别为 25Gy 和 40Gy。中位随访时间为 37.5 个月。分析时，166 例患者疾病复发，35 例患者局部失败。2 年局部控制（LC）和总生存（OS）率分别为 71.0%和 16.9%。每个十年结果的比较表明，OS 逐十年显著提高（2 年：25.0%比 18.8%比 4.2%，p<0.001）。多因素分析显示，切除程度（R0-1 与 R2，危险比=1.97，p=0.001）和辅助化疗（是与否，危险比=1.54，p=0.028）对 OS 有显著影响。根据不良事件通用术语标准 3.0 版，有 4 例患者观察到胃肠道晚期毒性 4 或 5 级。
使用 IORT 可实现对胰腺癌的良好局部控制，且严重迟发性毒性病例较少。接受 IORT±EBRT 治疗的胰腺癌患者的 OS 逐十年显著提高。多因素分析显示，切除程度和辅助化疗对 OS 有显著影响。
