Combination of perioperative chemotherapy and intraoperative radiotherapy for the treatment of resectable pancreatic head cancer

Abstract

Introduction: A new treatment method involving neoadjuvant chemoembolization of tumor vessels 5 days prior to surgery combined with intraoperative radiotherapy (IORT) followed by adjuvant chemotherapy was established for patients with resectable pancreatic cancer. The aim of the present study was to assess the safety and efficacy of this treatment scheme. Method: Records of 161 patients with resectable PDAC treated in Botkin Hospital between 2013–2017 were reviewed. In 49 cases was used perioperative chemoradiotherapy (PeriCRT). IORT was performed using Carl Zeiss Intrabeam PRS 500 system. After resection stage, a single dose of 20 Gy IORT boost was delivered using 50-kV x-rays to a depth of 1 mm from the applicator surface. Afterward a histological examination and electron microscopy of irradiated resection margin were performed. Results: All 161 patients with PDAC underwent gross total resection (R0) with lymphadenectomy D2. The estimated median survival was 338, 358, 372 and 337 days. Long-term survival was 70,2% (NACE), 75,1% (IORT), 80,7% (PeriCRT), 61,3% (control) for 3-year survival, respectively (p < 0,05, 95% Cl). All treatment methods were well tolerated by all patients, with few adverse effects and no serious complications. There was no association between outcomes, variations in tumor characteristics, marker concentrations and therapeutic response. Conclusions: Good 3-year OS for resected PDAC was achieved by using novel PeriCRT treatment method.