[Intraoperative radiotherapy combined with extended resection for pancreatic cancer]

Since 1984, intraoperative radiotherapy combined with extended resection for pancreatic cancer has been performed in our clinic to prevent local recurrence. Following extended resection, a dose of 30 Gy of 9-12 MeV electrons was administered to the operative field including the paraaortic area from the diaphragm above to the inferior mesenteric artery below. Results of the combined therapy of 35 patients were compared to results of 11 patients who underwent extended resection alone. The combined therapy group compared to extended resection alone group showed improvement in the survival rate. It's 5 year survival rate was 16.8% in all the 35 cases, 22.3% in patients who had macroscopic tumor clearance and 18.9% in patients with Stage IVa tumour according to The Japanese classification. In autopsies of 10 cases who underwent the combined therapy, only 4 had local recurrence enclosed by thick, firm connective tissue. There was no any local recurrence in 2 cases who underwent non curative resection. Enhanced local control induced by the combined therapy, however, only has a limited impact on overall survival, because of system disease progression, especially hepatic metastases. These results suggest that combination of IORT and extended resection should be performed on selected patients to control local recurrence and anticancer treatment for metastases of the liver must be established for the cure of pancreatic cancer as soon as possible.