Gotoh M, Monden M, Sakon M, Kanai T, Umeshita K, Ikeda H, Mori T
Department of Surgery II, Osaka University Medical School, Japan.
Nihon Geka Gakkai Zasshi. 1993 Mar;94(3):269-76.
Intraoperative radiotherapy (IORT) which was originally used for unresectable cancer has been applied to the cases after pancreas resection. However, it has not been clarified which stages of patients will have the beneficial effect of IORT on their prognosis. In this study, IORT after pancreas resection was appraised on the basis of the patient prognosis. Seventy-two pancreatectomized patients including 6 cases of Stage I, 18 cases of Stage II, 25 cases of Stage III and 23 cases of Stage IV, which was determined by the general rules for cancer of the pancreas in Japan Pancreas Society were employed in this study. Four cases of Stage III and 15 cases of Stage IV were treated with IORT (25-30 Gy) after pancreatectomy. Ten of these patients underwent postoperative external beam radiotherapy (22-48 Gy). All but one case of Stage I were currently alive. The median survival time (MST) of Stage II were 908 days and 2 cases were alive over 5 year after operation. MST of Stage III without IORT was 310 pod and all died within 906 pod. In contrast, all four Stage III patients were currently alive without a sign of recurrence (3, 10, 15, 57 pom). All Stage IV cases without IORT died within 462 pod, while three cases with IORT were alive over this period. These data suggest IORT improves the prognosis of Stage III patients when combined with radical resection of the pancreas. But it is not the case with the more advanced cases, where systemic anticancer adjuvant therapy might be indicated.
术中放疗（IORT）最初用于无法切除的癌症，现已应用于胰腺切除术后的病例。然而，尚未明确哪些分期的患者会从IORT中获得预后益处。在本研究中，基于患者预后对胰腺切除术后的IORT进行了评估。本研究纳入了72例行胰腺切除术的患者，根据日本胰腺学会制定的胰腺癌通用规则确定，其中I期6例、II期18例、III期25例、IV期23例。19例III期和IV期患者在胰腺切除术后接受了IORT（25 - 30 Gy）治疗。其中10例患者接受了术后外照射放疗（22 - 48 Gy）。除1例I期患者外，其余患者目前均存活。II期患者的中位生存时间（MST）为908天，2例术后存活超过5年。未接受IORT的III期患者的MST为310天，均在906天内死亡。相比之下，所有4例接受IORT的III期患者目前均存活，无复发迹象（3、10、15、57个月）。所有未接受IORT的IV期患者均在462天内死亡，而3例接受IORT的患者在此期间存活。这些数据表明，IORT与胰腺根治性切除联合应用可改善III期患者的预后。但对于更晚期的病例并非如此，可能需要进行全身抗癌辅助治疗。
