[An appraisal of intraoperative radiotherapy for pancreas cancer]

Intraoperative radiotherapy (IORT) which was originally used for unresectable cancer has been applied to the cases after pancreas resection. However, it has not been clarified which stages of patients will have the beneficial effect of IORT on their prognosis. In this study, IORT after pancreas resection was appraised on the basis of the patient prognosis. Seventy-two pancreatectomized patients including 6 cases of Stage I, 18 cases of Stage II, 25 cases of Stage III and 23 cases of Stage IV, which was determined by the general rules for cancer of the pancreas in Japan Pancreas Society were employed in this study. Four cases of Stage III and 15 cases of Stage IV were treated with IORT (25-30 Gy) after pancreatectomy. Ten of these patients underwent postoperative external beam radiotherapy (22-48 Gy). All but one case of Stage I were currently alive. The median survival time (MST) of Stage II were 908 days and 2 cases were alive over 5 year after operation. MST of Stage III without IORT was 310 pod and all died within 906 pod. In contrast, all four Stage III patients were currently alive without a sign of recurrence (3, 10, 15, 57 pom). All Stage IV cases without IORT died within 462 pod, while three cases with IORT were alive over this period. These data suggest IORT improves the prognosis of Stage III patients when combined with radical resection of the pancreas. But it is not the case with the more advanced cases, where systemic anticancer adjuvant therapy might be indicated.