Trodella L, Morganti A G, Valentini V, Doglietto G, Cellini N, Crucitti F
Istituto di Radiologia, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Roma.
Rays. 1995 Jul-Sep;20(3):316-25.
Pancreatic tumors represent a major field of application of intraoperative radiotherapy (IORT) with electron beams. First clinical studies were carried out principally on unresectable tumors and control of pain was observed in most of them. However, as for prognosis, IORT alone has yielded disappointing results. The use of IORT to boost external beam radiotherapy (ERT) frequently applied in recent trials, has improved local control but not survival rate because of the high incidence of abdominal metastasis. To-date, results of IORT used as an adjuvant to radical surgery have been controversial. As in unresectable tumors, studies have been focused on the combination IORT+ERT, however the intensification of the dose delivered to the tumor bed and the consequent better local control has not resulted in a better prognosis. A more significant contribution of IORT to the treatment of pancreatic tumors may come in the future from the combination of IORT with more effective methods in the control of the abdominal disease ("prophylactic" ERT to the liver or upper abdomen, intra-arterial or intraperitoneal chemotherapy) or from variously timed combinations with ERT (neoadjuvant ERT+IORT).
胰腺肿瘤是术中电子束放射治疗（IORT）的一个主要应用领域。最初的临床研究主要针对无法切除的肿瘤，大多数患者的疼痛得到了控制。然而，就预后而言，单纯的IORT效果令人失望。在最近的试验中，IORT常被用于增强外照射放疗（ERT），这提高了局部控制率，但由于腹部转移的高发生率，生存率并未提高。迄今为止，IORT作为根治性手术辅助治疗的结果一直存在争议。与无法切除的肿瘤一样，研究集中在IORT+ERT联合治疗上，然而，增加肿瘤床的照射剂量以及随之而来的更好的局部控制并未带来更好的预后。未来，IORT对胰腺肿瘤治疗的更大贡献可能来自于IORT与控制腹部疾病的更有效方法（对肝脏或上腹部进行“预防性”ERT、动脉内或腹腔内化疗）的联合应用，或者来自于与ERT不同时间的联合应用（新辅助ERT+IORT）。
