Intraoperative radiotherapy and bypass surgery for unresectable pancreatic cancer.

Background/Aims: Conflicting results have been reported concerning the asefuiness of radiotherapy for unresectable pancreatic cancer. We evaluated the chnical efficacy of intraoperative rathotherapy and/or external beam radiotherapy in combination with bypass surgery. Methodology: Twenty-six patients with unresectable pancreatic cancer (16 in Stage II-III and 10 in Stage IV) were treated with intranperatise radiotherapy plus external beam radiotherapy (16 patients) or intraoperative radiotherapy alone (10 patients. The dose of intraoperative radiotherapy was either 25 or 30Gy and the external beam radiotherapy dose was 31-60Gy. The feambility and chnical outcome were analyzed. Results: The median survival time for Stage II-III and Stage IV were 11.5 and 6.5 months, respectively. The difference between Stage II-III and Stage IV in survival patterns was stallstically significant (P<0.05). For Stage II-III patients, the survival curves between the groups of intraoperative radiotherapy plus external beam radiotherapy and intraoperative radiotherapy alone were not significantly different, and only performance status was a significant factor in the prognosis (P<0.05). Gastrointestinal bleeding was noted in 8%, but did not occur in the patients treated with an external beam radiotherapy dose less than 50Gy. Palliative radiation was stiecessfully performed to relieve pain, jaundice and appetite-loss and to shorten the hospital stay. Conclusions: The combination therapy with intraoperative radiotherapy and bypass surgery is considered to be tolerable and effective for unreseals able pancreatic cancer, and also may improve the quality of lifa of the patients.