Song Xiaodong, Shao Zili, Liang Huihong
Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Guangzhou Medical University, No. 250, Changgang Road, Guangzhou, 510260, People's Republic of China.
J Med Case Rep. 2019 Jan 26;13(1):23. doi: 10.1186/s13256-018-1906-6.
Pancreatic cancer is one of the most common fatal malignancies and has a poor prognosis. Surgical treatment is the most important treatment method, but there is a low rate of radical excision; moreover, the postoperative recurrence rate is high, with a local recurrence rate greater than 50%. The usefulness of intraoperative radiotherapy for pancreatic cancer has previously been examined. However, prior research was based on the traditional high-energy electron beam, which causes serious radiation toxicity. Therefore, the tumor radiation dose was limited, subsequently limiting the effect. In contrast, there is also a low-energy X-ray radiation system called INTRABEAM®. Use of INTRABEAM has been applied clinically, but the treatment effect of INTRABEAM in pancreatic cancer has not been reported.
We present a case of a 56-year-old Chinese man with local advanced pancreatic cancer with invasion of the coeliac trunk artery and origin of the portal vein. He underwent distal pancreatectomy and splenectomy along with intraoperative radiotherapy using a portable INTRABEAM radiation system. The radiotherapy dose was 10 Gy and irradiation time was 27.4 minutes. There were no obvious postoperative complications. His abdominal pain was alleviated after surgery, and no obvious tumor recurrence has been observed in short-term follow-up.
We believe that it is safe to apply intraoperative radiotherapy using the INTRABEAM radiation system in pancreatic cancer. This approach appears promising for further future development.
胰腺癌是最常见的致命恶性肿瘤之一，预后较差。手术治疗是最重要的治疗方法，但根治性切除率较低；此外，术后复发率高，局部复发率大于50%。术中放疗对胰腺癌的有效性此前已得到研究。然而，先前的研究基于传统的高能电子束，会导致严重的放射毒性。因此，肿瘤辐射剂量受到限制，进而限制了疗效。相比之下，有一种名为INTRABEAM®的低能X射线辐射系统。INTRABEAM的应用已在临床上开展，但INTRABEAM在胰腺癌中的治疗效果尚未见报道。
我们报告一例56岁中国男性患者，患有局部晚期胰腺癌，侵犯腹腔干动脉并累及门静脉起始部。他接受了远端胰腺切除术和脾切除术，并使用便携式INTRABEAM辐射系统进行术中放疗。放疗剂量为10 Gy，照射时间为27.4分钟。术后无明显并发症。术后他的腹痛得到缓解，短期随访未观察到明显肿瘤复发。
我们认为，在胰腺癌中应用INTRABEAM辐射系统进行术中放疗是安全的。这种方法在未来的进一步发展中似乎很有前景。
