COMBINED INTRAOPERATIVE RADIATION AND PERIOPERATIVE CHEMOTHERAPY FOR UNRESECTABLE CANCERS OF THE PANCREAS

Purpose: To evaluate the effectiveness of combined intraoperative radiation therapy (IORT) and perioperative chemotherapy in the management of unresectable pancreatic cancer. Materials and Methods: Forty-nine patients with localized unresectable adenocarcinoma of the pancreas were treated in a multimodality program of initial IORT and perioperative chemotherapy (fluorouracil [5-FU]/leucovorin) followed by combined external-beam radiation (40 to 55 Gy) and continued chemotherapy. Patients were evaluated for toxicity, pattern of failure, and survival, The follow-up times of these patients range from a minimum of 12 months to a maximum of 62 months, with a median of 28 months. Results: The incidence of perioperative mortality was 0%. Early postsurgical morbidity (grade 3/4) was observed in seven of 49 patients (14%) and late treatment-related morbidity (grade 3/4) in eight of 43 patients (19%) alive beyond 6 months, Morbidity was primarily gastrointestinal (GI), with no hematologic toxicities observed, The median survival time in the total group of patients is 16 months, with a 2-year survival rate of 22% and a 4-year survival rate of 7%, Freedom from local progression of disease was achieved in 71% of patients. Conclusion: The patients who undergo IORT with electrons and treated with perioperative chemotherapy (5-FU leucovorin) followed by additional external-beam radiation and chemotherapy appear to have improved survival, with few early or lore complications, Dose escalation of external-beam radiation and chemotherapy may further improve local control of disease and survival of patients. (C) 1995 by American Society of Clinical Oncology.