Is adjuvant intra-operative radiotherapy (IORT) for resectable and unresectable pancreatic carcinoma worthwhile?

The hitherto limited experience with IORT has demonstrated that the combined treatment modality of surgery and IORT with or without EBRT is feasible in resectable and unresectable pancreatic cancer. IORT in combination with EBRT has not significantly improved median or overall survival, but local tumor control and pain control rates have increased. The major complication of IORT in unresectable pancreatic cancer is hemorrhage from the upper gastrointestinal tract in 20% of the patients. Hence, prophylactic by-passes should be performed after IORT treatment. The exact value of IORT in the treatment of pancreatic cancer is still to be defined. A prospective randomized phase III trial is necessary to evaluate the true value of IORT in the treatment of pancreatic cancer.