Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.
BMC Cancer. 2012 Jul 18;12:295. doi: 10.1186/1471-2407-12-295.
To evaluate the use of intraoperative radiation therapy (IORT) in the multimodality treatment of patients with isolated local recurrences of pancreatic cancer.
We retrospectively analyzed 36 patients with isolated local recurrences of pancreatic cancer who have been treated with a combination of surgery, IORT and EBRT. Median time from initial treatment to recurrence was 20 months. All patients were surgically explored. In 18 patients a gross total resection was achieved, whereas the other half received only debulking or no resection at all. All patients received IORT with a median dose of 15 Gy. Additional EBRT was applied to 31 patients with a median dose of 45 Gy, combined with concurrent, mainly gemcitabine-based chemotherapy.
Median follow-up in surviving patients was 23 months. Local progression was found in 6 patients after a median time of 17 months, resulting in estimated 1- and 2-year local control rates of 91% and 67%, respectively. Distant failure was observed in 23 patients, mainly in liver or peritoneal space. The median estimated progression-free survival was 9 months with 1- and 2-year rates of 40% and 26%, respectively. We found an encouraging estimated median overall survival of 19 months, transferring into 1- and 2-year rates of 66% and 45%. Notably 6 of 36 patients (17%) lived for more than 3 years. Severe postoperative complications were found in 3 and chemoradiation-related grade III toxicity in 6 patients. No severe IORT related toxicity was observed.
Combination of surgery, IORT and EBRT in patients with isolated local recurrences of pancreatic cancer resulted in encouraging local control and overall survival in our cohort with acceptable toxicity. Our approach seems to be superior to palliative chemotherapy or chemoradiation alone and should be further investigated in a prospective setting specifically addressing isolated local recurrences of pancreatic cancer.
评估术中放疗（IORT）在多模式治疗孤立性胰腺癌局部复发病例中的应用。
我们回顾性分析了 36 例孤立性胰腺癌局部复发病例，这些患者接受了手术、IORT 和 EBRT 的联合治疗。从初始治疗到复发的中位时间为 20 个月。所有患者均接受了手术探查。18 例患者行根治性切除术，而另一半患者仅行减瘤术或根本不行切除术。所有患者均接受了中位剂量为 15 Gy 的 IORT。31 例患者接受了额外的 EBRT，中位剂量为 45 Gy，并联合了同步、主要基于吉西他滨的化疗。
存活患者的中位随访时间为 23 个月。17 个月后，6 例患者出现局部进展，估计 1 年和 2 年局部控制率分别为 91%和 67%。23 例患者出现远处转移，主要在肝脏或腹膜腔。中位无进展生存期为 9 个月，1 年和 2 年的无进展生存率分别为 40%和 26%。我们发现，令人鼓舞的估计中位总生存期为 19 个月，1 年和 2 年的总生存率分别为 66%和 45%。值得注意的是，36 例患者中有 6 例（17%）存活超过 3 年。3 例患者出现严重术后并发症，6 例患者出现放化疗相关的 III 级毒性。未观察到严重的 IORT 相关毒性。
在孤立性胰腺癌局部复发病例中，手术、IORT 和 EBRT 的联合应用在我们的队列中取得了令人鼓舞的局部控制和总生存效果，且毒性可接受。我们的方法似乎优于姑息性化疗或单纯放化疗，应在专门针对孤立性胰腺癌局部复发的前瞻性研究中进一步探讨。
