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Article: Long-term outcomes of extended radical resection combined with intraoperative radiation therapy for pancreatic cancer.

Takamori, Hiroshi / Hiraoka, Takehisa / Kanemitsu, Keiichiro / Tsuji, Tatsuya / Tanaka, Hiroshi / Chikamoto, Akira / Horino, Kei / Beppu, Toru / Hirota, Masahiko / Baba, Hideo

Journal of hepato-biliary-pancreatic surgery

2008 Volume 15, Issue 6, Page(s) 603–607

Abstract: ... with intraoperative radiation therapy in patients with PC, and all the patients were followed for more than 5 years ... for pancreatic cancer (PC). To prevent local relapse we adopted an extended radical resection combined ... Methods: We assessed the long-term outcomes of 41 patients who underwent this combined therapy ...

Abstract	Background/purpose: Systemic and/or local recurrence often occurs even after curative resection for pancreatic cancer (PC). To prevent local relapse we adopted an extended radical resection combined with intraoperative radiation therapy in patients with PC, and all the patients were followed for more than 5 years. Methods: We assessed the long-term outcomes of 41 patients who underwent this combined therapy. The cumulative survival curve in this series was depicted using the Kaplan-Meier method. Statistical analyses were performed using the log-rank test. Results: The actual 5-year survival rate was 14.6%, with a median survival time of 17.6 months. Six patients have been 5-year survivors. Local recurrence occurred in only 2 patients (5.0%). Cancer-related death occurred in 32 patients, 18 of whom had liver metastases. The patients with liver metastases had a significantly shorter survival time than those with other cancer-related causes of death. Patients with n3 lymph node involvement, extrapancreatic nerve plexus invasion, and stage IV disease had significantly poorer prognoses than patients without these characteristics. Conclusions: Our combined therapy for patients with PC contributed to local control; however, it provided no survival benefit, because of liver metastases.
MeSH term(s)	Adult ; Aged ; Combined Modality Therapy ; Female ; Humans ; Liver Neoplasms/secondary ; Lymph Node Excision ; Male ; Middle Aged ; Neoplasm Recurrence, Local/prevention & control ; Pancreatectomy/methods ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/radiotherapy ; Pancreatic Neoplasms/surgery ; Prognosis ; Survival Rate ; Treatment Outcome
Language	English
Publishing date	2008
Publishing country	Japan
Document type	Journal Article
ZDB-ID	1181222-9
ISSN	1436-0691 ; 0944-1166
ISSN (online)	1436-0691
ISSN	0944-1166
DOI	10.1007/s00534-007-1323-5
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Article: Pancreatic resection combined with intraoperative radiation therapy for pancreatic cancer.

Huiras, C M

Annals of surgery

1999 Volume 230, Issue 6, Page(s) 827

MeSH term(s)	Humans ; Intraoperative Period ; Pancreatectomy ; Pancreatic Neoplasms/mortality ; Pancreatic Neoplasms/radiotherapy ; Pancreatic Neoplasms/surgery ; Radiotherapy, Adjuvant ; Research Design ; Treatment Outcome
Language	English
Publishing date	1999-12
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/00000658-199912000-00017
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Article: Pancreatic resection combined with intraoperative radiation therapy for pancreatic cancer.

Farrell, T J / Barbot, D J / Rosato, F E

Annals of surgery

1997 Volume 226, Issue 1, Page(s) 66–69

Abstract: ... of pancreatic carcinoma with a combination of pancreatic resection and intraoperative radiation therapy (IORT ... Conclusions: Intraoperative radiation therapy is a useful adjunct to surgical resection as treatment ... Summary background data: Pancreatic cancer is the most lethal form of gastrointestinal malignancy ...

Abstract	Objective: The objective of the study was to analyze a single center's experience in the treatment of pancreatic carcinoma with a combination of pancreatic resection and intraoperative radiation therapy (IORT). Summary background data: Pancreatic cancer is the most lethal form of gastrointestinal malignancy. Historically, it carries a 20% 1-year survival and a 5-year survival of 3% to 5%. Since 1987, patients at Thomas Jefferson University Hospital have been offered IORT in an attempt to improve their survival. Methods: The authors reviewed all patients treated at Thomas Jefferson University Hospital with pancreatic adenocarcinoma from 1987 to 1994. From this population, 14 patients were identified who received IORT in conjunction with curative surgery. Duration of hospital stay, perioperative complications, duration of postoperative ileus, and survival were assessed by retrospective review. Results: Of the 14 patients, 6 were male and 8 were female. Patient median age was 61. Six patients had stage I disease, 2 had stage II, 6 had stage III. Two patients had total pancreatectomy, 2 had distal pancreatectomy, and the remaining had pancreaticoduodenectomy (Whipple resection). Median survival was 16 months with a 15.5% 5-year survival. Postoperative complications, duration of hospital stay, and duration of postoperative ileus were not adversely affected by the addition of IORT when compared to in-house control subjects. Conclusions: Intraoperative radiation therapy is a useful adjunct to surgical resection as treatment of pancreatic cancer. The authors' data suggested it can prolong median survival and long-term survival without adding significant morbidity.
MeSH term(s)	Adenocarcinoma/mortality ; Adenocarcinoma/radiotherapy ; Adenocarcinoma/surgery ; Case-Control Studies ; Combined Modality Therapy ; Female ; Humans ; Intraoperative Care ; Male ; Middle Aged ; Pancreatectomy ; Pancreatic Neoplasms/mortality ; Pancreatic Neoplasms/radiotherapy ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy ; Radiotherapy Dosage ; Radiotherapy, High-Energy ; Retrospective Studies ; Survival Rate ; Time Factors
Language	English
Publishing date	1997-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/00000658-199707000-00009
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Article ; Online: CivaSheet intraoperative radiation therapy for pancreatic cancer.

Taylor, Ross J / Todor, Dorin / Kaplan, Brian J / Stover, Weston / Fields, Emma C

Brachytherapy

2022 Volume 21, Issue 2, Page(s) 255–259

Abstract: ... a multidisciplinary approach with chemotherapy, radiation and surgical resection. Despite using chemotherapy and ... The treatment of borderline resectable (BR) pancreatic cancer is challenging and requires ... early patient outcomes with the CivaSheet in pancreatic cancer. ...

Abstract	The treatment of borderline resectable (BR) pancreatic cancer is challenging and requires a multidisciplinary approach with chemotherapy, radiation and surgical resection. Despite using chemotherapy and radiotherapy in the neoadjuvant setting, achievement of negative surgical margins remains technically challenging. Positive margins are associated with increased local recurrences and worse overall survival and there are no standard options for treatment. The CivaSheet is an FDA-cleared implantable sheet with a matrix of unidirectional planar low-dose-rate (LDR) Palladium-103 (Pd-103) sources. The sources are shielded on one side with gold to spare radio-sensitive structures such as the bowel. The sheet can easily be customized and implanted at the time of surgery when there is concern for close or positive margins. The CivaSheet provides an interesting solution to target the region of close/positive margins after pancreatectomy. Here we discuss the physical properties, the dosimetry, clinical workflow and early patient outcomes with the CivaSheet in pancreatic cancer.
MeSH term(s)	Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Brachytherapy/methods ; Humans ; Neoadjuvant Therapy ; Palladium/therapeutic use ; Pancreatic Neoplasms/radiotherapy ; Pancreatic Neoplasms/surgery ; Radioisotopes/therapeutic use
Chemical Substances	Radioisotopes ; Palladium (5TWQ1V240M) ; Palladium-103 (68QTV136DF)
Language	English
Publishing date	2022-01-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2098608-7
ISSN	1873-1449 ; 1538-4721
ISSN (online)	1873-1449
ISSN	1538-4721
DOI	10.1016/j.brachy.2021.10.007
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Article: Treatment strategies for hepatic metastases from pancreatic cancer in patients previously treated with radical resection combined with intraoperative radiation therapy.

Takamori, H / Hiraoka, T / Kanemitsu, K / Tsuji, T / Saito, N / Nishida, H / Sakaguchi, H / Miyauchi, Y

HPB surgery : a world journal of hepatic, pancreatic and biliary surgery

1994 Volume 8, Issue 2, Page(s) 107–110

Abstract: ... radiation therapy (IORT) for pancreatic cancer. This approach has provided a dramatic improvement in long-term ... Since 1984, we have performed extended radical resection combined with extended intraoperative ... Among patients with this combined therapy, we found hepatic metastases in 8 of 22 patients postoperatively. Four ...

Abstract	Since 1984, we have performed extended radical resection combined with extended intraoperative radiation therapy (IORT) for pancreatic cancer. This approach has provided a dramatic improvement in long-term survival and control of local recurrence. Hepatic metastases, however, remain an unsolved problem. Among patients with this combined therapy, we found hepatic metastases in 8 of 22 patients postoperatively. Four of these 8 were considered candidates for further therapy and underwent treatment for their hepatic metastases, the other 4 had too extensive disease. Two patients with multiple hepatic metastases underwent percutaneous ethanol injection therapy and chemotherapy, but they died within a year. Two patients with a solitary hepatic metastases underwent hepatic resection. One patient died two years and six months after the first operation because of multiple metastases in the liver and both lungs, while the other patient is still alive over six years after the first operation with an excellent performance status. When a patient has no local recurrence and a solitary metastasis in the liver, surgical resection of the liver metastasis should be performed.
MeSH term(s)	Adenocarcinoma/secondary ; Adenocarcinoma/surgery ; Adenocarcinoma/therapy ; Aged ; Combined Modality Therapy ; Hepatectomy ; Humans ; Liver Neoplasms/secondary ; Liver Neoplasms/surgery ; Liver Neoplasms/therapy ; Male ; Middle Aged ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/radiotherapy ; Pancreatic Neoplasms/surgery
Language	English
Publishing date	1994
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	1025964-8
ISSN	1607-8462 ; 0894-8569
ISSN (online)	1607-8462
ISSN	0894-8569
DOI	10.1155/1994/61323
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Zs.A 2850: Show issues

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Article ; Online: Selective Radical Resection for Unresectable Pancreatic Cancer

Changku Jia / Ling Liu / Hanzhang Zhu / Weimin Shen / Chunfeng Yang

BioMedica, Vol 36, Iss 4, Pp 405-

2021 Volume 411

Abstract: Background and Objective: For inefficiency of chemotherapy and radiation against pancreatic cancer ... vein as well as resection and reconstruction of combined organs were performed. Operation time ... resection rate for primary unresectable pancreatic cancer remains very low. This study was carried out ...

Abstract	Background and Objective: For inefficiency of chemotherapy and radiation against pancreatic cancer, resection rate for primary unresectable pancreatic cancer remains very low. This study was carried out to evaluate the safety and value of radical resection for unresectable pancreatic cancer (UPC). Methods: Clinical data were analyzed retrospectively. In unresectable group, 360° resection of the involved artery sheath, resection and reconstruction of the involved artery, resection and reconstruction of the involved vein as well as resection and reconstruction of combined organs were performed. Operation time, intraoperative blood loss, ICU transitional treatment, pancreatic fistula, bleeding, reoperation and survival time were analyzed for two groups. Results: Operation time and intraoperative blood loss were greatly increased in the unresectable group. The incidence of intractable diarrhea and abdominal hemorrhage in the unresectable group were higher. However, the rate of ICU transitional therapy, delayed gastric emptying and reoperation were lower. Grade-C pancreatic fistula occurred in neither group. Conclusion: Surgical treatment through stringent selection for patients with unresectable pancreatic cancer is a safer technique and median post-operative survival time is similar to patients with resectable pancreatic cancer.
Keywords	Medicine ; R ; Biology (General) ; QH301-705.5
Subject code	610
Language	English
Publishing date	2021-03-01T00:00:00Z
Publisher	Discover STM Publishing Ltd
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A phase II study of intraoperative radiotherapy using a low-energy x-ray source for resectable pancreatic cancer: a study protocol.

Kim, Jun Won / Cho, Yeona / Kim, Hyung Sun / Choi, Won Hoon / Park, Joon Seong / Lee, Ik Jae

BMC surgery

2019 Volume 19, Issue 1, Page(s) 31

Abstract: ... the potential to improve the efficacy of radiation therapy for pancreatic cancer.: Methods/design ... thus, the long-term outcome of locally advanced pancreatic cancer remains poor. Intraoperative radiotherapy (IORT ... Background: The current standard treatment for resectable pancreatic cancer is surgical resection ...

Abstract	Background: The current standard treatment for resectable pancreatic cancer is surgical resection followed by adjuvant chemotherapy. Local recurrence rates are high even after curative resection; thus, the long-term outcome of locally advanced pancreatic cancer remains poor. Intraoperative radiotherapy (IORT) uses a low-energy x-ray source to deliver a single fraction of high-dose radiation to the tumor bed during a surgical procedure, while effectively sparing the surrounding normal tissues. IORT has the potential to improve the efficacy of radiation therapy for pancreatic cancer. Methods/design: This prospective, one-armed, phase II study will investigate the role of IORT in improving local control in patients with resectable pancreatic adenocarcinoma. The patients will receive surgery and IORT of 10 Gy prescribed at a 5-mm depth of the tumor bed, followed by adjuvant gemcitabine chemotherapy according to the current standard of care. The aim is to enroll 42 patients. Discussion: The primary endpoint of this trial is to evaluate the feasibility of IORT and the local recurrence rate after one year. The secondary endpoints include the acute and late toxicities, and disease-free survival and overall survival rates. Trial registration: The trial was prospectively registered at Clinicaltrials.gov NCT03273374 on September 6, 2017.
MeSH term(s)	Adenocarcinoma/radiotherapy ; Adenocarcinoma/surgery ; Combined Modality Therapy ; Humans ; Intraoperative Care ; Pancreatic Neoplasms/radiotherapy ; Pancreatic Neoplasms/surgery ; Prospective Studies ; Radiotherapy, Adjuvant
Language	English
Publishing date	2019-03-07
Publishing country	England
Document type	Clinical Trial, Phase II ; Journal Article
ZDB-ID	2050442-1
ISSN	1471-2482 ; 1471-2482
ISSN (online)	1471-2482
ISSN	1471-2482
DOI	10.1186/s12893-019-0492-x
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Article ; Online: A phase II trial proposal of total neoadjuvant treatment with primary chemotherapy, stereotactic body radiation therapy, and intraoperative radiation therapy in borderline resectable pancreatic adenocarcinoma.

BMC cancer

2021 Volume 21, Issue 1, Page(s) 165

Abstract: ... radiation therapy modalities, including stereotactic body radiation therapy (SBRT) and intraoperative ... radiation therapy (IORT), could result in a more effective neoadjuvant strategy, with higher rates of margin-free ... to-treat, phase II trial newly diagnosed BRPC will receive a "total neoadjuvant" therapy with FOLFIRINOX (5 ...

Abstract	Background: The current management guidelines recommend that patients with borderline resectable pancreatic adenocarcinoma (BRPC) should initially receive neoadjuvant chemotherapy. The addition of advanced radiation therapy modalities, including stereotactic body radiation therapy (SBRT) and intraoperative radiation therapy (IORT), could result in a more effective neoadjuvant strategy, with higher rates of margin-free resections and improved survival outcomes. Methods/design: In this single-center, single-arm, intention-to-treat, phase II trial newly diagnosed BRPC will receive a "total neoadjuvant" therapy with FOLFIRINOX (5-fluorouracil, irinotecan and oxaliplatin) and hypofractionated SBRT (5 fractions, total dose of 30 Gy with simultaneous integrated boost of 50 Gy on tumor-vessel interface). Following surgical exploration or resection, IORT will be also delivered (10 Gy). The primary endpoint is 3-year survival. Secondary endpoints include completion of neoadjuvant treatment, resection rate, acute and late toxicities, and progression-free survival. In the subset of patients undergoing resection, per-protocol analysis of disease-free and disease-specific survival will be performed. The estimated sample size is 100 patients over a 36-month period. The trial is currently recruiting. Trial registration: NCT04090463 at clinicaltrials.gov.
MeSH term(s)	Adenocarcinoma/pathology ; Adenocarcinoma/therapy ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Chemoradiotherapy/methods ; Clinical Trials, Phase II as Topic ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Intraoperative Care ; Male ; Middle Aged ; Neoadjuvant Therapy/methods ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/therapy ; Prognosis ; Radiosurgery/methods ; Survival Rate
Language	English
Publishing date	2021-02-16
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article
ISSN	1471-2407
ISSN (online)	1471-2407
DOI	10.1186/s12885-021-07877-7
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Article ; Online: Adjuvant Chemoradiation in Pancreatic Cancer: A Pooled Analysis in Elderly (≥75 years) Patients.

Mattiucci, Gian-Carlo / Falconi, Massimo / VAN Stiphout, Ruud G P M / Alfieri, Sergio / Calvo, Felipe A / Herman, Joseph M / Maidment, Bert W / Miller, Robert C / Regine, William F / Reni, Michele / Sharma, Navesh / Partelli, Stefano / Genovesi, Domenico / Balducci, Mario / Deodato, Francesco / Valentini, Vincenzo / Morganti, Alessio G

Anticancer research

2015 Volume 35, Issue 6, Page(s) 3441–3446

Abstract: ... with intraoperative radiotherapy (IORT) and postoperative death.: Results: A total of 98 patients were included ... resection of pancreatic adenocarcinoma (PAC) in elderly (≥75 years) patients.: Materials and methods ... Aim: To determine the impact of postoperative chemoradiation (POCR) on overall survival (OS) after ...

Abstract	Aim: To determine the impact of postoperative chemoradiation (POCR) on overall survival (OS) after resection of pancreatic adenocarcinoma (PAC) in elderly (≥75 years) patients. Materials and methods: A multi-center retrospective review of 1248 patients who underwent complete resection with macroscopically negative margins (R0-1) for invasive PAC was performed. Exclusion criteria included age <75 years, metastatic or unresectable disease at surgery, macroscopic residual disease (R2), treatment with intraoperative radiotherapy (IORT) and postoperative death. Results: A total of 98 patients were included in the analysis (males=39.8%, females=60.2%; R1 resections=33.7%; pN1=61.2%); 63 patients received POCR and 26 patients received adjuvant chemotherapy alone. The median follow-up was 25.6 months. The mean age for the entire cohort of patients was 78.1±2.9 (SD) years. No differences were observed between patients receiving or not receiving POCR in terms of age (p=0.081), tumor diameter (p=0.412), rate of R1 resection (p=0.331) and incidence of lymph node-positive disease (p=0.078). The only factor predicting an improved OS was POCR. The median OS was 69.0 months in patients treated by POCR and 23.0 months in patients treated without POCR (p=0.008). Even by Cox multivariate analysis, the only significant predictor of OS was POCR (hazard ratio=0.449; 95% confidence interval=0.212-0.950; p=0.036). Conclusion: The study represents the first comparative approach on POCR in elderly patients after resection of PAC. OS was higher in patients who received POCR. Further analyses are warranted to evaluate the toxicity rate/grade and the impact of POCR on patient quality of life.
MeSH term(s)	Adenocarcinoma/drug therapy ; Adenocarcinoma/epidemiology ; Adenocarcinoma/pathology ; Adenocarcinoma/radiotherapy ; Aged ; Aged, 80 and over ; Combined Modality Therapy ; Female ; Humans ; Male ; Pancreatic Neoplasms/drug therapy ; Pancreatic Neoplasms/epidemiology ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/radiotherapy ; Prognosis ; Proportional Hazards Models ; Quality of Life ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2015-06
Publishing country	Greece
Document type	Journal Article ; Multicenter Study
ZDB-ID	604549-2
ISSN	1791-7530 ; 0250-7005
ISSN (online)	1791-7530
ISSN	0250-7005
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Article ; Online: Chemoradiation therapy sequencing for resected pancreatic adenocarcinoma in the National Cancer Data Base.

Colbert, Lauren E / Hall, William A / Nickleach, Dana / Switchenko, Jeffrey / Kooby, David A / Liu, Yuan / Gillespie, Theresa / Lipscomb, Joseph / Kauh, John / Landry, Jerome C

Cancer

2014 Volume 120, Issue 4, Page(s) 499–506

Abstract: ... recurrence rates following surgical resection. The role for preoperative radiation therapy (prRT) for PAC ... were obtained for all patients who underwent resection and external beam radiation (RT) for PAC ... from 1998 to 2002. Patients with metastatic (M1) disease, intraoperative RT, RT both before and after ...

Abstract	Background: Pancreatic adenocarcinoma (PAC) has low overall survival (OS) rates and high recurrence rates following surgical resection. The role for preoperative radiation therapy (prRT) for PAC versus postoperative RT (poRT) remains uncertain. The authors used the National Cancer Data Base (NCDB) to report prRT outcomes for the largest multi-institutional patient cohort to date. Methods: NCDB data were obtained for all patients who underwent resection and external beam radiation (RT) for PAC from 1998 to 2002. Patients with metastatic (M1) disease, intraoperative RT, RT both before and after surgery, missing OS, or missing RT variables were excluded. Univariate (UV) and multivariate (MV) analysis were run using treatment characteristics, tumor characteristics, and patient demographics. The difference in patients' known characteristics was described by a chi-square test or analysis of variance. Results: A total of 5414 patients were identified. Of these, 277 received prRT and 5137 received poRT. Overall, 92.9% received chemotherapy and 7.1% received RT alone; 56% (2990 of 5307) of patients had stage III disease, according to American Joint Commission on Cancer (AJCC) staging manual, 5th edition. Median tumor size was 3 cm (range: 0-9.9 cm); 82% (199 of 244) of patients with prRT had negative surgical margins; 72% (3383 of 4699) of patients with poRT had negative margins. Forty-one percent (71 of 173) of patients with prRT were lymph node (LN)-positive; 65% (3159 of 4833) of patients with poRT were LN-positive. Median OS for patients with prRT was 18 months (95% CI = 18-19 months) and for patients with poRT, 19 months (95% CI = 17-22 months). Conclusions: Receipt of prRT was associated with lower stage, higher rates of negative margins, and lower rates of lymph node positivity at resection. However, there was no significant difference in median OS versus that of the poRT group.
MeSH term(s)	Adenocarcinoma/epidemiology ; Adenocarcinoma/pathology ; Adenocarcinoma/radiotherapy ; Adenocarcinoma/surgery ; Adult ; Aged ; Aged, 80 and over ; Chemoradiotherapy ; Combined Modality Therapy ; Databases, Factual ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Pancreatic Neoplasms/epidemiology ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/radiotherapy ; Pancreatic Neoplasms/surgery ; Postoperative Period ; Treatment Outcome ; United States
Language	English
Publishing date	2014-01-03
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1429-1
ISSN	1097-0142 ; 0008-543X ; 1934-662X
ISSN (online)	1097-0142
ISSN	0008-543X ; 1934-662X
DOI	10.1002/cncr.28530
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