Intraoperative radiotherapy in malignant HPB diseases combine treatment

Abstract

Introduction: Insufficient results after pancreatic cancer and colorectal liver metastasis surgical treatment require additional treatment methods. Methods: 18 patients with colorectal liver metastasis (CRM) and 23 patients with pancreatic head cancer were treated by intraoperative radiotherapy (IORT) in Botkin Moscow Municipal Hospital. IORT was performed using Carl Zeiss Intrabeam PRS 500 system. After resection stage a single dose of 10–15 Gy IORT boost was delivered using 50-kV X-rays to surgery surface from the applicator. Applicators were used from the size 2.5 to 5 cm. Then was made an electron microscopy study of irradiated surgery margin. Results: All of 18 patients with CRM underwent liver resection (R0) with IORT and 23 patients underwent Whipple procedure with IORT.The median dose of IORT was 12 Gy. After electron microscopy examination it was observed fat cells and endothelium destruction. The median follow-up period was 30 months. At the time of the analysis, 7 (39%) patients from CRM IORT group had disease recurrence (new liver metastasis in the same and others liver segments). The 2-year local control (LC) and overall survival (OS) rates were 61% and 74%. As for pancreatic cancer group, 8(35%) had disease recurrence (liver metastasis). The 2-year local control (LC) and overall survival (OS) rates were 82% and 64%. Conclusion: Effective influence by Carl Zeiss Intrabeam PRS 500 system on local reccurence, overal survival and liver tissue and pancreatic head bed was confirmed.