[Peroperative radiotherapy in tumors of the pancreas]

Intraoperative irradiation has been devised as a method to safely deliver higher radiation doses to the tumors while minimizing the dose to the surrounding normal tissues. Among 14 patients treated by intraoperative radiotherapy in our institution, 8 had a pancreatic carcinoma (unresected in 7 patients, and partially resected in 1 patient). Anesthetized patients were transferred with the incision temporarily closed from the fourth floor operative room to the basement accelerator suite. A single dose of 15 to 20 Gy with 20meV electrons was delivered. Five patients with a carcinoma of the head of the pancreas had had a biliary and a digestive by-pass. After surgery all the patients received an additional 40 Gy and chemotherapy with 5-Fluorouracil. There was nor post-operative mortality neither morbidity. Four patients with preoperative pain had no pain after treatment. Five patients died after 5 to 10 months and two patients are alive with a follow-up of 4 and 9 months. Because of the short follow-up and the small number of patients no conclusion on survival may be made. Nevertheless, in other experiences good palliation has been generally obtained. Significant difference in survival time was noticed in a Japanese experience in unresected cases. In 16 patients with resected carcinomas a 41% survival rate at 2 years has been observed in a North American experience. Thus we are encouraged to continue this approach.