Huguier M, Schlienger M, Houry S, Lacaine F, Charron R
Service de Chirurgie digestive, Hôpital Tenon, Paris.
Presse Med. 1987 Nov 28;16(40):2009-12.
Intra-operative 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 12 patients treated by intraoperative radiotherapy in our institution, 7 had a pancreatic carcinoma (unresected in 6 patients, and partially resected in 1). Anesthetized patients were transferred with the incision temporarily closed from the fourth floor operating theatre to the basement accelerator suite. A single dose of 15 to 20 Gy with 20 MeV electrons was delivered. Five of these patients with carcinoma of the head of the pancreas then had a biliary and a digestive bypass. After surgery, all patients received an additional 40 Gy and chemotherapy with 5-fluorouracil. There was neither post-operative mortality nor morbidity. Three patients with pre-operative pain had no pain following treatment. Five patients died after 5 to 10 months and two patients are alive with a follow-up of 4 and 9 months respectively. Because of the short follow-up and small number of patients, no conclusions concerning survival can be drawn. Nevertheless, in other experiences good palliative results have generally been obtained. Significant differences in survival time were noted in a japanese experience of unresected cases. In 16 patients with resected carcinoma a 41% survival rate at 2 years has been observed in 1 North American study. These results suggest that intra-operative irradiation is worth further trials.
术中放疗已被设计为一种在将对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辐射剂量的方法。在我们机构接受术中放疗的12例患者中，7例患有胰腺癌（6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。用20兆电子伏的电子单次给予15至20戈瑞的剂量。其中5例胰头癌患者随后进行了胆肠和消化道旁路手术。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。术后既无死亡率也无发病率。3例术前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例患者分别存活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，通常已取得良好的姑息治疗效果。在日本对未切除病例的经验中，观察到生存时间存在显著差异。在一项北美研究中，16例切除癌患者的2年生存率为41%。这些结果表明术中放疗值得进一步试验。
