Fossati V, Cattaneo G M, Zerbi A, Galli L, Bordogna G, Reni M, Parolini D, Carlucci M, Bissi A, Staudacher C
Radiation-Oncology Department, Istituto Nazionale Tumori, Milan, Italy.
Tumori. 1995 Jan-Feb;81(1):23-31. doi: 10.1177/030089169508100106.
In the treatment of pancreatic carcinomas, one modality is intraoperative radiotherapy (IORT). A study was carried out to assess the feasibility of IORT alone or in a multimodality approach with postoperative adjuvant chemotherapy and external radiotherapy and to compare local control and survival of patients. Another objective of this retrospective study was to verify prognostic factors in resected patients treated with IORT.
From January 1985 through September 1992, 54 adenocarcinomas of the pancreas (unresectable and resected patients) were treated with IORT by electron beam at the San Raffaele Hospital and then analyzed. Comparison was also carried out between IORT-treated resected patients and a non-randomized control group of resected patients treated without IORT in the same period.
In unresectable patients treated by laparotomy bypass and IORT, overall median survival was 6 months and 8 months in non-metastatic patients. Relief of severe pain present in 14 patients was observed in 85% within 12 days of IORT. As regards resected patients, the most important finding was that significantly better local control resulted from IORT. In fact, overall, local relapses were 25% in the IORT group and 55.8% in the non-IORT group (control group); instead, survival of the IORT group was not significantly longer than that of the control group. From a statistical analysis of resected patients treated with IORT and performed on prognostic factors on the basis of available data, survival was significantly influenced by tumor pathologic grading and diameter; postoperative adjuvant therapy was not a significant prognosis factor.
IORT has a role in local control of unresectable pancreatic carcinomas and in control of resultant severe pain. In resected patients, IORT is effective in decreasing local recurrences but has little impact on survival. To obtain more satisfactory results, new and more effective adjuvant therapies and better abdominal prophylaxis should be tested.
在胰腺癌的治疗中，一种方式是术中放疗（IORT）。开展了一项研究，以评估单纯IORT或与术后辅助化疗及外照射放疗联合的多模式治疗方法的可行性，并比较患者的局部控制情况和生存率。这项回顾性研究的另一个目的是验证接受IORT治疗的切除患者的预后因素。
1985年1月至1992年9月，圣拉斐尔医院对54例胰腺腺癌患者（不可切除和可切除患者）进行了电子束IORT治疗，随后进行分析。还对接受IORT治疗的可切除患者与同期未接受IORT治疗的可切除患者的非随机对照组进行了比较。
在接受剖腹手术旁路和IORT治疗的不可切除患者中，非转移性患者的总体中位生存期为6个月和8个月。在IORT治疗后12天内，观察到14例患者存在的严重疼痛有85%得到缓解。对于可切除患者，最重要的发现是IORT能显著更好地实现局部控制。事实上，总体而言，IORT组的局部复发率为25%，非IORT组（对照组）为55.8%；相反，IORT组的生存期并不显著长于对照组。对接受IORT治疗的可切除患者根据现有数据进行预后因素的统计分析，结果显示生存期受肿瘤病理分级和直径的显著影响；术后辅助治疗不是一个显著的预后因素。
IORT在不可切除胰腺癌的局部控制及由此产生的严重疼痛控制方面发挥作用。在可切除患者中，IORT可有效减少局部复发，但对生存期影响不大。为获得更满意的结果，应试验新的、更有效的辅助治疗方法和更好的腹部预防措施。
