Effectiveness of multimodality treatment for resectable pancreatic cancer

Since November 1983, 16 patients with resectable pancreatic cancer have been treated by a multimodality approach at the National Cancer Center Hospital. This therapy included extended pancreatic resection, intraoperative irradiation by 30 Gy of electrons, and intraoperative hepatic arterial or portal infusion of mitomycin C. Furthermore, postoperative chemotherapy with mitomycin C, using Seldinger's method or intravenously, was added. The patients consisted of 12 with carcinoma of the pancreatic head and four with carcinoma of the body and tail. The 1- and 3-yr survival rates for these patients were 88 and 53%, respectively. The rates were markedly better than the 26 and 10% after conventional radical pancreatectomy from 1962 to 1983. The cancers consisted of Stage I, 1 case; II, 1; III, 11; and IV, 3 according to the p-TNM pathological classification by UICC, and the 1- and 3-yr survival rates for the 14 patients other than those with Stage I and II were 85 and 57%, respectively. According to our experience, pancreatic carcinoma usually pursues an aggressive course and is unlikely to be cured by surgery alone. A multimodality therapy in addition to radical surgery appears to be necessary in the treatment of resectable pancreatic cancer.