Intraoperative Radiotherapy for Resectable Pancreatic Cancer Using a Low-Energy X-Ray Source: Postoperative Complications and Early Outcomes

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

Abstract

Purpose: We evaluated the safety, feasibility, and early treatment outcomes of intraoperative radiotherapy (IORT) using a low-energy X-ray source.

Materials and methods: Patients with resectable pancreatic cancer were enrolled in this single-institution, prospective, single-arm, phase II trial. Patients underwent surgery and IORT with 10 Gy prescribed at a 5-mm depth from the tumor bed using a 50 kV X-ray source (Intrabeam, Carl Zeiss). Six cycles of adjuvant gemcitabine-based chemotherapy were administered 8-12 weeks after surgery.

Results: A total of 41 patients were included. Thirty-one patients (75.6%) underwent wide R0 resection, while 5 (12.2%) underwent R1 resection and 5 (12.2%) underwent narrow R0 resection (retroperitoneal margin <1 mm). Grade 3 postoperative complications were reported in only one patient (4.9%) who needed additional surgery due to ulcer perforation. At a median follow-up of 9 months, four patients showed local-only recurrence, nine had distant metastases, and two showed both local and distant recurrence. The 1-year local control rate was 76.4%.

Conclusion: Our preliminary report suggests that IORT is well-tolerated and feasible in patients with resectable pancreatic cancer. Further follow-up is needed to confirm the clinical benefits of IORT in terms of local control and overall survival.

Trial registration: Trial Registration: Clinical trial registration No. (NCT03273374).

Keywords: Pancreatic neoplasms; postoperative complications; radiotherapy; recurrence; x-ray therapy.

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

© Copyright: Yonsei University College of Medicine 2022.

Figures

Fig. 1. Shielding device of the spherical…
Fig. 1. Shielding device of the spherical applicator. Only the bottom surface of the applicator is covered with plastic, while all other parts are shielded by steel use stainless steel.
Fig. 2. Patients selection for this analysis.…
Fig. 2. Patients selection for this analysis. IORT, intraoperative radiotherapy.
Fig. 3. Kaplan-Meir survival analysis according to…
Fig. 3. Kaplan-Meir survival analysis according to the initial CA19-9 level. (A) Local control rate. (B) Disease-free survival. (C) Distant metastasis-free survival. (D) Overall survival. CA19-9, carbohydrate antigen 19-9.

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Source: PubMed

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