Huguier M, Schlienger M, Houry S, Negro D, Charron R
Minerva Chir. 1989 Mar 15;44(5):827-32.
Intraoperative irradiation has been devised as a method to safely deliver higher radiation doses to the tumors while minimizing the dose to the surrounding normal tissues. Among 14 patients treated by intraoperative radiotherapy in our institution, 8 had a pancreatic carcinoma (unresected in 7 patients, and partially resected in 1 patient). Anesthetized patients were transferred with the incision temporarily closed from the fourth floor operative room to the basement accelerator suite. A single dose of 15 to 20 Gy with 20meV electrons was delivered. Five patients with a carcinoma of the head of the pancreas had had a biliary and a digestive by-pass. After surgery all the patients received an additional 40 Gy and chemotherapy with 5-Fluorouracil. There was nor post-operative mortality neither morbidity. Four patients with preoperative pain had no pain after treatment. Five patients died after 5 to 10 months and two patients are alive with a follow-up of 4 and 9 months. Because of the short follow-up and the small number of patients no conclusion on survival may be made. Nevertheless, in other experiences good palliation has been generally obtained. Significant difference in survival time was noticed in a Japanese experience in unresected cases. In 16 patients with resected carcinomas a 41% survival rate at 2 years has been observed in a North American experience. Thus we are encouraged to continue this approach.
术中放疗已被设计为一种方法，可在将周围正常组织的剂量降至最低的同时，安全地向肿瘤输送更高的辐射剂量。在我们机构接受术中放疗的14例患者中，8例患有胰腺癌（7例未切除，1例部分切除）。麻醉后的患者在切口暂时缝合的情况下，从四楼手术室转移至地下室加速器室。使用20兆电子伏的电子束单次给予15至20戈瑞的剂量。5例胰头癌患者进行了胆道和消化道旁路手术。术后所有患者均接受了额外的40戈瑞放疗及5-氟尿嘧啶化疗。术后无死亡病例，也无并发症发生。4例术前有疼痛的患者治疗后疼痛消失。5例患者在5至10个月后死亡，2例患者存活，随访时间分别为4个月和9个月。由于随访时间短且患者数量少，无法得出关于生存的结论。然而，在其他经验中，通常能获得良好的姑息治疗效果。在日本未切除病例的经验中，观察到生存时间有显著差异。在北美经验中，16例切除癌患者的2年生存率为41%。因此，我们受到鼓舞继续采用这种方法。
