Abstract
BackgroundTo evaluate the use of intraoperative radiation therapy (IORT) in the multimodality treatment of patients with isolated local recurrences of pancreatic cancer.MethodsWe retrospectively analyzed 36 patients with isolated local recurrences of pancreatic cancer who have been treated with a combination of surgery, IORT and EBRT. Median time from initial treatment to recurrence was 20 months. All patients were surgically explored. In 18 patients a gross total resection was achieved, whereas the other half received only debulking or no resection at all. All patients received IORT with a median dose of 15 Gy. Additional EBRT was applied to 31 patients with a median dose of 45 Gy, combined with concurrent, mainly gemcitabine-based chemotherapy.ResultsMedian follow-up in surviving patients was 23 months. Local progression was found in 6 patients after a median time of 17 months, resulting in estimated 1- and 2-year local control rates of 91% and 67%, respectively. Distant failure was observed in 23 patients, mainly in liver or peritoneal space. The median estimated progression-free survival was 9 months with 1- and 2-year rates of 40% and 26%, respectively. We found an encouraging estimated median overall survival of 19 months, transferring into 1- and 2-year rates of 66% and 45%. Notably 6 of 36 patients (17%) lived for more than 3 years. Severe postoperative complications were found in 3 and chemoradiation-related grade III toxicity in 6 patients. No severe IORT related toxicity was observed.ConclusionCombination of surgery, IORT and EBRT in patients with isolated local recurrences of pancreatic cancer resulted in encouraging local control and overall survival in our cohort with acceptable toxicity. Our approach seems to be superior to palliative chemotherapy or chemoradiation alone and should be further investigated in a prospective setting specifically addressing isolated local recurrences of pancreatic cancer.
Highlights
To evaluate the use of intraoperative radiation therapy (IORT) in the multimodality treatment of patients with isolated local recurrences of pancreatic cancer
We retrospectively reviewed our patients with isolated local recurrences of pancreatic cancer after primary resection, who have been treated at our institution with a more aggressive approach consisting of surgery, IORT and external beam radiation therapy (EBRT)
We identified a total of 42 patients with isolated local recurrences of pancreatic cancer in the database of the University of Heidelberg, who have been treated with IORT between 2002 and 2009
Summary
To evaluate the use of intraoperative radiation therapy (IORT) in the multimodality treatment of patients with isolated local recurrences of pancreatic cancer. While surgical resection is the only potential curative treatment approach for pancreatic cancer, and an isolated local recurrence represents a potentially curable situation, the majority of these patients will be treated with palliative chemotherapy or chemoradiation alone. This raises the question, if a more aggressive local therapy could be beneficial at least for some of these patients. We retrospectively reviewed our patients with isolated local recurrences of pancreatic cancer after primary resection, who have been treated at our institution with a more aggressive approach consisting of surgery, IORT and EBRT
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