Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1984 Sep;200(3):289–296. doi: 10.1097/00000658-198409000-00006

Intraoperative electron beam irradiation for patients with unresectable pancreatic carcinoma.

W U Shipley, W C Wood, J E Tepper, A L Warshaw, E L Orlow, S D Kaufman, G E Battit, G L Nardi
PMCID: PMC1250473  PMID: 6205632

Abstract

Since 1978 we have used electron beam intraoperative radiation therapy (IORT) to deliver higher radiation doses to pancreatic tumors than are possible with external beam techniques while minimizing the dose to the surrounding normal tissues. Twenty-nine patients with localized, unresectable, pancreatic carcinoma were treated by electron beam IORT in combination with conventional external radiation therapy (XRT). The primary tumor was located in the head of the pancreas in 20 patients, in the head and body in six patients, and in the body and tail in three. Adjuvant chemotherapy was given in 23 of the 29 patients. The last 13 patients have received misonidazole (3.5 mg/M2) just prior to IORT (20 Gy). At present 14 patients are alive and 11 are without evidence of disease from 3 to 41 months after IORT. The median survival is 16.5 months. Eight patients have failed locally in the IORT field and two others failed regionally. Twelve patients have developed distant metastases, including five who failed locally or regionally. We have seen no local recurrences in the 12 patients who have been treated with misonidazole and have completed IORT and XRT while 10 of 15 patients treated without misonidazole have recurred locally. Because of the shorter follow-up in the misonidazole group, this apparent improvement is not statistically significant. Fifteen patients (52%) have not had pain following treatment and 22 (76%) have had no upper gastrointestinal or biliary obstruction subsequent to their initial surgical bypasses and radiation treatments. Based on the good palliation generally obtained, the 16.5-month median survival, and the possible added benefit from misonidazole, we are encouraged to continue this approach.

Full text

PDF
289

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Edis A. J., Kiernan P. D., Taylor W. F. Attempted curative resection of ductal carcinoma of the pancreas: review of Mayo Clinic experience, 1951-1975. Mayo Clin Proc. 1980 Sep;55(9):531–536. [PubMed] [Google Scholar]
  2. Goldson A. L., Ashaveri E., Espinoza M. C., Roux V., Cornwell E., Rayford L., McLaren M., Nibhanupudy R., Mahan A., Taylor H. F. Single high dose intraoperative electrons for advanced stage pancreatic cancer: phase I pilot study. Int J Radiat Oncol Biol Phys. 1981 Jul;7(7):869–874. doi: 10.1016/0360-3016(81)90002-x. [DOI] [PubMed] [Google Scholar]
  3. Haslam J. B., Cavanaugh P. J., Stroup S. L. Radiation therapy in the treatment of irresectable adenocarcinoma of the pancreas. Cancer. 1973 Dec;32(6):1341–1345. doi: 10.1002/1097-0142(197312)32:6<1341::aid-cncr2820320609>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
  4. Komaki R., Wilson J. F., Cox J. D., Kline R. W. Carcinoma of the pancreas: results of irradiation for unresectable lesions. Int J Radiat Oncol Biol Phys. 1980 Feb;6(2):209–212. doi: 10.1016/0360-3016(80)90039-5. [DOI] [PubMed] [Google Scholar]
  5. Malt R. A. Treatment of pancreatic cancer. JAMA. 1983 Sep 16;250(11):1433–1437. [PubMed] [Google Scholar]
  6. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966 Mar;50(3):163–170. [PubMed] [Google Scholar]
  7. Morrow M., Hilaris B., Brennan M. F. Comparison of conventional surgical resection, radioactive implantation, and bypass procedures for exocrine carcinoma of the pancreas 1975-1980. Ann Surg. 1984 Jan;199(1):1–5. doi: 10.1097/00000658-198401000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Shipley W. U., Nardi G. L., Cohen A. M., Ling C. C. Iodine-125 implant and external beam irradiation in patients with localized pancreatic carcinoma: a comparative study to surgical resection. Cancer. 1980 Feb 15;45(4):709–714. doi: 10.1002/1097-0142(19800215)45:4<709::aid-cncr2820450416>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  9. Tepper J., Nardi G., Sutt H. Carcinoma of the pancreas: review of MGH experience from 1963 to 1973. Analysis of surgical failure and implications for radiation therapy. Cancer. 1976 Mar;37(3):1519–1524. doi: 10.1002/1097-0142(197603)37:3<1519::aid-cncr2820370340>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  10. Tryka A. F., Brooks J. R. Histopathology in the evaluation of total pancreatectomy for ductal carcinoma. Ann Surg. 1979 Sep;190(3):373–381. doi: 10.1097/00000658-197909000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Whittington R., Dobelbower R. R., Mohiuddin M., Rosato F. E., Weiss S. M. Radiotherapy of unresectable pancreatic carcinoma: a six year experience with 104 patients. Int J Radiat Oncol Biol Phys. 1981 Dec;7(12):1639–1644. doi: 10.1016/0360-3016(81)90185-1. [DOI] [PubMed] [Google Scholar]
  12. Wood W. C., Shipley W. U., Gunderson L. L., Cohen A. M., Nardi G. L. Intraoperative irradiation for unresectable pancreatic carcinoma. Cancer. 1982 Mar 15;49(6):1272–1275. doi: 10.1002/1097-0142(19820315)49:6<1272::aid-cncr2820490632>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES