La radioterapia intraoperatoria corne trattamento adiuvante alla resezione nel carcinoma del pancreas

Local recurrence is the most frequent site of failure after resection for pancreatic cancer. We reported our experience in term of tolerance, local control and survival obtained by the association of resection and intraoperative radiation therapy (IORT). Between January 1985 and July 1996 152 resection for pancreatic cancer were performed at the authors' institution. For 77 patients, IORT was added to resection (group 1), whereas the other 75 patients underwent resection alone (group 2), because of either the unavailability of the linear accelerator or the patient's refusal. In group 1, radiation doses from 12.5 to 20 Gy, with electron beam energies between 6 and 12 MeV, were delivered. Extension of the disease, percentage of radical resection and postoperative chemotherapy were similar in the two groups of patients. Operative mortality and overall early postoperative complications were respectively 1.3% and 31.2% in group 1 and 4% and 32% in group 2. The median survival was 17 months in group 1 and 15 months in group 2 and the median disease free survival was 12 months in group 1 and 8 months in group 2. A local recurrence was detected in 31% of patients in group 1 and in 49.3% of patients in group 2 (p <0.1). The results suggest a better local control in patients with pancreatic cancer undergoing adjuvant IORT.