Carcinoma of the pancreatic head area. Therapy: intraoperative radiotherapy

Pancreatic tumors represent a major field of application of intraoperative radiotherapy (IORT) with electron beams. First clinical studies were carried out principally on unresectable tumors and control of pain was observed in most of them. However, as for prognosis, IORT alone has yielded disappointing results. The use of IORT to boost external beam radiotherapy (ERT) frequently applied in recent trials, has improved local control but not survival rate because of the high incidence of abdominal metastasis. To-date, results of IORT used as an adjuvant to radical surgery have been controversial. As in unresectable tumors, studies have been focused on the combination IORT+ERT, however the intensification of the dose delivered to the tumor bed and the consequent better local control has not resulted in a better prognosis. A more significant contribution of IORT to the treatment of pancreatic tumors may come in the future from the combination of IORT with more effective methods in the control of the abdominal disease ("prophylactic" ERT to the liver or upper abdomen, intra-arterial or intraperitoneal chemotherapy) or from variously timed combinations with ERT (neoadjuvant ERT+IORT).