International Journal of Radiation Oncology * Biology * Physics
Volume 77, Issue 3 , Pages 734-742 , 1 July 2010

Intraoperative Radiotherapy for Resected Pancreatic Cancer: A Multi-Institutional Retrospective Analysis of 210 Patients

  • Kazuhiko Ogawa, M.D.

      Affiliations

    • Department of Radiology, University of the Ryukyus, Okinawa, Japan
    • Corresponding Author InformationReprint requests to: Dr. Kazuhiko Ogawa, Department of Radiology, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan. Tel: (81) 98-895-3331(ext. 2401); Fax: (81) 98-895-1420
    • ,
  • Katsuyuki Karasawa, M.D.

      Affiliations

    • Department of Radiation Oncology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
    • ,
  • Yoshinori Ito, M.D.

      Affiliations

    • Department of Radiation Oncology, National Cancer Center, Tokyo, Japan
    • ,
  • Yoshihiro Ogawa, M.D.

      Affiliations

    • Department of Radiation Oncology, Tohoku University, Sendai, Japan
    • ,
  • Keiichi Jingu, M.D.

      Affiliations

    • Department of Radiation Oncology, Tohoku University, Sendai, Japan
    • ,
  • Hiroshi Onishi, M.D.

      Affiliations

    • Department of Radiology, Yamanashi University, Yamanashi, Japan
    • ,
  • Shinichi Aoki, M.D.

      Affiliations

    • Department of Radiology, Yamanashi University, Yamanashi, Japan
    • ,
  • Hitoshi Wada, M.D.

      Affiliations

    • Department of Radiation Oncology, Yamagata University, Yamagata, Japan
    • ,
  • Masaki Kokubo, M.D.

      Affiliations

    • Department of Radiation Oncology, Institute of Biomedical Research and Innovation Hospital, Kobe, Japan
    • ,
  • Hidehiro Etoh, M.D.

      Affiliations

    • Department of Radiology, Kurume University, Kurume, Japan
    • ,
  • Tomoko Kazumoto, M.D.

      Affiliations

    • Department of Radiation Oncology, Saitama Cancer Center, Saitama, Japan
    • ,
  • Makoto Takayama, M.D.

      Affiliations

    • Department of Radiation Oncology, Kyorin University, Tokyo, Japan
    • ,
  • Yoshiharu Negoro, M.D.

      Affiliations

    • Department of Radiation Oncology, Tenri Hospital, Nara, Japan
    • ,
  • Kenji Nemoto, M.D.

      Affiliations

    • Department of Radiation Oncology, Yamagata University, Yamagata, Japan
    • ,
  • Yasumasa Nishimura, M.D.

      Affiliations

    • Department of Radiation Oncology, Kinki University School of Medicine, Osaka, Japan
    • ,
  • JROSG Working Subgroup of Gastrointestinal Cancers

Received 8 July 2009 ,Revised 5 September 2009 ,Accepted 16 September 2009.

References 

  1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71–96
  2. Gudjonsson B. Cancer of the pancreas: 50 years of surgery. Cancer. 1987;60:2284–2303
  3. 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;37:1519–1524
  4. Griffin JF, Smalley SR, Jewell W, et al. Patterns of failure after curative resection of pancreatic carcinoma. Cancer. 1990;66:56–61
  5. Bosset JF, Pavy JJ, Gillet M, et al. Conventional external irradiation alone as adjuvant treatment in resectable pancreatic cancer: Results of a prospective study. Radiother Oncol. 1992;24:191–194
  6. Rich TA, Evans DB, Curley SA, et al. Adjuvant radiotherapy and chemotherapy for biliary and pancreatic cancer. Ann Oncol. 1994;5(Suppl. 3):75–80
  7. Evans DB, Abbruzzese JL, Rich TA. Cancer of the pancreas. In:  DeVita VT,  Hellmann S,  Rosenberg SA editor. Cancer: principles and practice of oncology. 5th ed. Philadelphia: Lippincott; 1997;p. 1054–1087
  8. Ruano-Ravina A, Almazán Ortega R, Guedea F. Intraoperative radiotherapy in pancreatic cancer: A systematic review. Radiother Oncol. 2008;87:318–325
  9. Ogawa K, Ito Y, Karasawa K, et al. Patterns of radiotherapy practice for pancreatic cancer in Japan: Results of the Japanese Radiation Oncology Study Group (JROSG) Survey. Int J Radiat Oncol Biol Phys. In press.
  10. Sobin LH, Wittelind C. TNM classification of malignant tumours. 6th ed.. New York: John Wiley; 2002;
  11. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481
  12. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966;50:163–170
  13. Cox DR. Regression models and life tables. J R Stat Soc. 1972;34:187–220
  14. Reni M, Panucci MG, Ferreri AJ, et al. Effect on local control and survival of electron beam intraoperative irradiation for resectable pancreatic adenocarcinoma. Int J Radiat Oncol Biol Phys. 2001;50:651–658
  15. O'Connor JK, Sause WT, Hazard LJ, et al. Survival after attempted surgical resection and intraoperative radiation therapy for pancreatic and periampullary adenocarcinoma. Int J Radiat Oncol Biol Phys. 2005;63:1060–1066
  16. Takamori H, Hiraoka T, Kanemitsu K, et al. Long-term outcomes of extended radical resection combined with intraoperative radiation therapy for pancreatic cancer. J Hepatobiliary Pancreat Surg. 2008;15:603–607
  17. Alfieri S, Morganti AG, Di Giorgio A, et al. Improved survival and local control after intraoperative radiation therapy and postoperative radiotherapy: A multivariate analysis of 46 patients undergoing surgery for pancreatic head cancer. Arch Surg. 2001;136:343–347
  18. Zerbi A, Fossati V, Parolini D, et al. Intraoperative radiation therapy adjuvant to resection in the treatment of pancreatic cancer. Cancer. 1994;73:2930–2935
  19. Sindelar WF. Clinical experience with regional pancreatectomy for adenocarcinoma of the pancreas. Arch Surg. 1989;124:127–132
  20. Fossati V, Cattaneo GM, Zerbi A, et al. The role of intraoperative therapy by electron beam and combination of adjuvant chemotherapy and external radiotherapy in carcinoma of the pancreas. Tumori. 1995;81:23–31
  21. Kokubo M, Nishimura Y, Shibamoto Y, et al. Analysis of the clinical benefit of intraoperative radiotherapy in patients undergoing macroscopically curative resection for pancreatic cancer. Int J Radiat Oncol Biol Phys. 2000;48:1081–1087
  22. Messick C, Hardacre JM, McGee MF, et al. Early experience with intraoperative radiotherapy in patients with resected pancreatic adenocarcinoma. Am J Surg. 2008;195:308–311
  23. Ozaki H, Kinoshita T, Kosuge T, et al. Effectiveness of multimodality treatment for resectable pancreatic cancer. Int J Pancreatol. 1990;7:195–200
  24. Hosotani R, Kogire M, Arii S, et al. Results of pancreatectomy with radiation therapy for pancreatic cancer. Hepatogastroenterology. 1997;44:1528–1535
  25. Okamoto A, Tsuruta K, Karasawa K, et al. Resection versus palliation: Treatment of stage III and IVA carcinomas of the pancreas employing intraoperative radiation. World J Surg. 2003;27:599–605
  26. Nishimura Y, Hosotani R, Shibamoto Y, et al. External and intraoperative radiotherapy for resectable and unresectable pancreatic cancer: Analysis of survival rates and complications. Int J Radiat Oncol Biol Phys. 1997;39:39–49
  27. Furuse J, Kinoshita T, Kawashima M, et al. Intraoperative and conformal external-beam radiation therapy with protracted 5-fluorouracil infusion in patients with locally advanced pancreatic carcinoma. Cancer. 2003;97:1346–1352
  28. Pisters PW, Wolff RA, Janjan NA, et al. Preoperative paclitaxel and concurrent rapid-fractionation radiation for resectable pancreatic adenocarcinoma: Toxicities, histologic response rates, and event-free outcome. J Clin Oncol. 2002;20:2537–2544
  29. Schwarz RE, Smith DD, Keny H, et al. Impact of intraoperative radiation on postoperative and disease-specific outcome after pancreatoduodenectomy for adenocarcinoma: A propensity score analysis. Am J Clin Oncol. 2003;26:16–21
  30. Herman JM, Swartz MJ, Hsu CC, et al. Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas: Results of a large, prospectively collected database at the Johns Hopkins Hospital. J Clin Oncol. 2008;26:3503–3510
  31. Corsini MM, Miller RC, Haddock MG, et al. Adjuvant radiotherapy and chemotherapy for pancreatic carcinoma: The Mayo Clinic experience (1975–2005). J Clin Oncol. 2008;26:3511–3516
  32. Moertel CG, Reitemeier RJ, Hahn RG. Mitomycin C therapy in advanced gastrointestinal cancer. JAMA. 1968;204:1045–1048
  33. Buroker T, Kim PN, Groppe C, et al. 5 FU infusion with mitomycin-C vs. 5 FU infusion with methyl-CCNU in the treatment of advanced upper gastrointestinal cancer: A Southwest Oncology Group Study. Cancer. 1979;44:1215–1221
  34. Burris HA, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: A randomized trial. J Clin Oncol. 1997;15:2403–2413
  35. Ikeda M, Okusaka T, Ito Y, et al. A phase I trial of S-1 with concurrent radiotherapy for locally advanced pancreatic cancer. Br J Cancer. 2007;96:1650–1655
  36. Childs HA, Spencer SA, Raben D, et al. A phase I study of combined UFT plus leucovorin and radiotherapy for pancreatic cancer. Int J Radiat Oncol Biol Phys. 2000;47:939–944
  37. Valentini V, Morganti AG, Macchia G, et al. Intraoperative radiation therapy in resected pancreatic carcinoma: Long-term analysis. Int J Radiat Oncol Biol Phys. 2008;70:1094–1099
  38. Stessin AM, Meyer JE, Sherr DL. Neoadjuvant radiation is associated with improved survival in patients with resectable pancreatic cancer: An analysis of data from the surveillance, epidemiology, and end results (SEER) registry. Int J Radiat Oncol Biol Phys. 2008;72:1128–1133
  39. Valentini V, Calvo F, Reni M, et al. Intra-operative radiotherapy (IORT) in pancreatic cancer: Joint analysis of the ISIORT-Europe experience. Radiother Oncol. 2009;91:54–59
  40. Tepper JE, Noyes D, Krall JM, et al. Intraoperative radiation therapy of pancreatic carcinoma: A report of RTOG-8505. Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys. 1991;21:1145–1149
  41. Sindelar WF, Kinsella TJ. Normal tissue tolerance to intraoperative radiotherapy. Surg Oncol Clin North Am. 2003;12:925–942

 Conflict of interest: none.

PII: S0360-3016(09)03203-9

doi: 10.1016/j.ijrobp.2009.09.010

International Journal of Radiation Oncology * Biology * Physics
Volume 77, Issue 3 , Pages 734-742 , 1 July 2010

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