[Peroperative radiotherapy in cancer of the pancreas]

Intra-operative 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 12 patients treated by intraoperative radiotherapy in our institution, 7 had a pancreatic carcinoma (unresected in 6 patients, and partially resected in 1). Anesthetized patients were transferred with the incision temporarily closed from the fourth floor operating theatre to the basement accelerator suite. A single dose of 15 to 20 Gy with 20 MeV electrons was delivered. Five of these patients with carcinoma of the head of the pancreas then had a biliary and a digestive bypass. After surgery, all patients received an additional 40 Gy and chemotherapy with 5-fluorouracil. There was neither post-operative mortality nor morbidity. Three patients with pre-operative pain had no pain following treatment. Five patients died after 5 to 10 months and two patients are alive with a follow-up of 4 and 9 months respectively. Because of the short follow-up and small number of patients, no conclusions concerning survival can be drawn. Nevertheless, in other experiences good palliative results have generally been obtained. Significant differences in survival time were noted in a japanese experience of unresected cases. In 16 patients with resected carcinoma a 41% survival rate at 2 years has been observed in 1 North American study. These results suggest that intra-operative irradiation is worth further trials.