Combined treatment using radiotherapy for carcinoma of the pancreas involving the adjacent vessels.

The prognosis of pancreatic duct carcinoma is determined mainly by the degree of local invasion, particularly of the portal system and/or associated arteries supplying the carcinoma. Intraoperative (25-36.5 Gy of betatron) and/or external (14.4-25.6 Gy, preoperatively, and 24-61.2 Gy, postoperatively, using lineac photon beams) radiotherapy was combined with pancreatectomy or by-pass surgery for patients with pancreatic carcinoma involving the surrounding vessels but with no distant metastases. Twelve- and 24-month survival rates were 25.9% and 3.2%, respectively, in patients with pancreatectomy (n = 35) and 6.4% and 0%, respectively, in patients with by-pass operations (n = 32). However, in patients with combined surgery and radiotherapy the prognosis was markedly improved to 12- and 24-month survival rates of 33.5% and 20.1%, respectively, for patients with pancreatectomy (n = 13) and rates of 25% and 13%, respectively, for patients with by-pass operations (n = 8). Moreover, radiotherapy produced a significant advantage for local control of pain in patients with unresectable pancreatic carcinoma. This suggests that combined treatment using radiotherapy will be a valuable therapeutic improvement for patients presenting advanced pancreatic carcinoma with vessel involvement.