Combination of intraoperative radiation with resection of Cancer of the pancreas
Combination of intraoperative radiation with resection of Cancer of the pancreas
复制标题
术中放疗与胰腺癌切除相结合
DOI：
10.1007/bf02924238
复制
发表时间：
1990
期刊：
影响因子：
--
通讯作者：
Yoshimasa Miyauchi
中科院分区：
文献类型：
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作者：
T. Hiraoka;R. Uchino;K. Kanemitsu;M. Toyonaga;N. Saitoh;I. Nakamura;Seiki Tashiro;Yoshimasa Miyauchi
术中放射治疗（IORT）作为胰腺癌手术切除术的辅助治疗的效用进行了研究。在1976年，作为我们的第一个试验与这种综合治疗，我们应用IORT与30戈伊的电子束与8 MeV的15例，以防止局部复发周围腹腔轴和上级肠系膜动脉后，标准胰腺切除术。然而，与19例单纯标准手术患者相比，联合治疗并未显示出生存率的改善。3例联合治疗患者的尸检未显示辐射野内受累淋巴结，但显示辐射野外主动脉周围局部复发，相比之下，我们对9例患者进行了无IORT的扩大手术，几乎完全清除了主动脉周围的淋巴结，从隔膜到肠系膜下动脉水平。因此，自1984年以来，我们对14例患者进行了IORT，剂量为30戈伊，9 MeV，辐射野从膈肌上方延伸到肠系膜下动脉下方。5年累积生存率为33.3%。4例尸检显示局部控制率提高。在胰腺切除术后接受延长IORT的患者中，术后未观察到放射相关并发症。我们被鼓励继续这种治疗胰腺癌的方法。
The utility of intraoperative radiation therapy (IORT) as an adjuvant to the surgical resection of pancreatic cancer was studied. In 1976, as our first trial with this combined therapy, we applied IORT with 30 Gy of electron beam with 8 MeV to 15 patients to prevent local recurrence around the celiac axis and superior mesenteric artery after standard pancreatectomy. However, the combined therapy did not show an improvement in survival rate as compared to that of 19 patients with standard operation alone. Autopsies of three patients with the combined therapy did not show involved lymph nodes in the radiation field, but did show local recurrence around the aorta outside the radiation field.By comparison, we performed extended operation without IORT on nine patients, with almost complete dissection of the lymph nodes around the aorta, from the diaphragm to the level of the inferior mesenteric artery. This extended surgery did not improve survival time, and autopsy showed local recurrence in spite of the dissection of lymph nodes.Therefore, since 1984, we have performed IORT with a dose of 30 Gy, 9 MeV, and an extended radiation field from the diaphragm above to the inferior mesenteric artery below, following extended operation on 14 patients. The five-year cumulative survival rate of these cases was 33.3%. Four autopsies showed improvement of local control rate. No radiation-related complications were noticed postoperatively in patients who underwent extended IORT following pancreatectomy. We were encouraged to continue this approach for the cure of pancreatic cancer.