Krempien Robert, Roeder Falk
Department of Radiation Oncology, Helios Clinic Berlin-Buch, Schwanebecker Chaussee 50, Berlin-Buch, 13125, Berlin, Germany.
Department of Radiation Oncology, University Hospital of Munich (LMU), Munich, Germany.
Radiat Oncol. 2017 Jan 10;12(1):8. doi: 10.1186/s13014-016-0753-0.
Despite the important improvements made in the fields of surgery, chemotherapy and radiation therapy, pancreatic cancer remains one of the most lethal malignancies. Improved outcomes with novel chemotherapy regimes led again to increased attention on the role of localized radiotherapy, since local tumor progression causes significant morbidity and mortality in patients. Even after resection local failure rates are as high as 50-80%. The immediate proximity to critical structures (bone marrow, spinal cord, kidneys, liver, and intestine) limits the dose of radiation that can be administered to the tumor bed with conventional external beam radiation therapy (EBRT). The intraoperative radiotherapy (IORT) appears to be an ideal therapeutic strategy for this disease, having the advantage of enabling the delivery of high doses of radiation to areas that are at risk for microscopic disease, saving critical organs and reducing the possibility of inducing radiotoxicity. This technique allows a theoretical increase in the radiation therapeutic index to tumor compared to the adjacent organs at risk (OAR). The aim of this review is to update and comment on IORT in the multidisciplinary management of pancreatic cancer.
尽管在手术、化疗和放射治疗领域取得了重要进展，但胰腺癌仍然是最致命的恶性肿瘤之一。新型化疗方案带来的疗效改善再次引发了人们对局部放疗作用的更多关注，因为局部肿瘤进展会给患者带来严重的发病率和死亡率。即使在切除术后，局部失败率仍高达50%-80%。由于胰腺紧邻关键结构（骨髓、脊髓、肾脏、肝脏和肠道），常规外照射放疗（EBRT）能够给予肿瘤床的辐射剂量受到限制。术中放疗（IORT）似乎是治疗这种疾病的理想策略，其优势在于能够向存在微小病灶风险的区域给予高剂量辐射，保护关键器官并降低诱发放射毒性的可能性。与相邻的危险器官（OAR）相比，该技术理论上可提高肿瘤的放射治疗指数。本综述的目的是更新并评论IORT在胰腺癌多学科管理中的应用。
