IOERT Or Combined With Chemoradiotherapy For Unresectable Locally Advanced Pancreatic Cancer

PART 1.IOERT alone for unresectable locally advanced pancreatic cancerObjective To assess prognostic benefits of intraoperative electron beam radiation therapy(IOERT)among patients with unresectable locally advanced pancreatic cancer.Patients and Methods Between January 2009 and December 2014,82 patients with unresectable locally advanced pancreatic cancer received IOERT in our hospital.The histological or cytological pathology of all patients was carcinoma.The dose of IOERT was 10-20Gy.Overall survival(OS),rates of disease progression and treatment toxicity were calculated.The following-up rate was 100%.Results The all of median survival time was 8.1 months and the 1-year OS rate was 40.4%.The all of median progression-free survival time was 5.2 months and the 1-year PFS rate was 26.8%.The all of median cancer specific mortality time was 8.1 months and the 1-year CSS rate was 42.6%.According the dose of IOERT,therre are three groups:the dose of<15Gy,15Gy and>15Gy.The median survival time of the three groups was 6.2 months vs.9.1 months vs.22.2 months respectively,and the 1-year OS rate was 10.0%vs.39.6%vs.77.4%(P<0.001)respectively.These results suggest that higher dose of IOERT appear to be necessary to achieve favorable OS.Gastrointestinal morbidity of National Cancer Institute-Common Terminology Criteria Grade 3 was observed in 2 patients.The abdominal pain and the bone marrow were 4 patients and 3 patients respectively.On univariate analysis,an IOERT dose(P<0.001),the tumor size(P=0.033),KPS(P=0.023)and the age(P=0.040)trended toward predicting improved OS.On multivariate analysis,the IOERT dose(P=0.001)was an independent prognostic factor.Conclusion IOERT might be an effective and safety treatment strategy for unresectable locally advanced pancreatic cancer.After protecting surrounding organs,increasing the IOERT dose can improve the survival.And the IOERT dose was the independent prognostic factors.PART 2.IOERT plus EBRT or CCRT for unresectable locally advanced pancreatic cancerObjective To retrospectively analyze the results of intraoperative electron irradiation(IOERT)+concurrent chemoradiation(CCRT)or external beam radiotherapy(EBRT)for unresectable locally advanced pancreatic cancer.Methods and Materials Between January 2009 and December 2014,65 patients with unresectable locally advanced pancreatic cancer received IOERT with EBRT or CCRT in our hospital.The histological or cytological pathology of all patients was carcinoma.53(81.5%)patients were treated with IOERT plus CCRT,and 12(18.5%)patients were theated with IOERT+EBRT.CCRT(30-46Gy/2-3Gy)was delivered with concurrent gemicitabine-based regimens.The dose of IOERT was 10-15Gy.Overall survival(OS),rates of disease progression and treatment toxicity were calculated.The following-up rate was 100%.Results The median survival time of the IOERT+EBRT and the IOERT+CCRT was 8.7 months vs.11.6 months respectively,and the 3-year OS rate was 0.0%vs.11.3%(P=0.042)respectively.Their median tumor-specific mortality time was 8.7 months vs.11.8 months respectively,and 3-year CSS rate was 0.0%vs.11.5%(P=0.038)respectively.Their median local control time was 7.9 months and 9.6 months,and the 1-year LC rate was 16.7%and 34.0%(P=0.282).Their median distant metastases control time was 6.6 months and 9.4 months,and the 1-year DM control rate was 25.0%and 37.7%(P=0.381).Gastrointestinal morbidity of National Cancer Institute-Common Terminology Criteria Grade 3 was observed in 2 patients.The abdominal pain and the bone marrow were 5 patients and 9 patients respectively.On univariate analysis,IOERT+CCRT(P=0.042)trended toward predicting improved OS.Conclusion Compare with IOERT+EBRT,IOERT+CCRT might be an more effective and safety treatment strategy for unresectable locally advanced pancreatic cancer.PART 3.IOERT followed by different adjuvant treatments for unresectable locally advanced pancreatic cancerObjective Multimodality therapy was commended by NCCN.While it still had a high rate of Local recurrence and distant metastasis.To evaluate intraoperative electron irradiation(IOERT)followed by different adjuvant treatments for unresectable locally advanced pancreatic cancer.Methods and Materials Between January 2009 and December 2014,79 patients with unresectable locally advanced pancreatic cancer received IOERT with different adjuvant treatments in our hospital.The histological or cytological pathology of all patients was carcinoma.53 patients were treated with IOERT plus CCRT,and 12 patients were theated with IOERT+EBRT,and 14 patients were treated with IOERT+chemotherapy.CCRT(30-46Gy/2-3Gy)was delivered wirh concurrent gemicitabine-based regimens.The dose of IOERT was 10-15Gy.Overall survival(OS),rates of disease progression and treatment toxicity were calculated..The following-up rate was 100%.Results The median survival time of the IOERT+EBRT,IOERT+CCRT and IOERT+ Chemotherapy was 8.7 months vs.11.6 months vs.11.5 months respectively,and the 3-year OS rate was 0.0%vs.26.2%vs.11.3%(P=0.112)respectively.The median local control time of the IOERT+chemotherapy and IOERT+CCRT was 6.8 months and 9.6 months(P=0.577),and their median distant metastases control time was 7.2 months and 9.4 months(P=0.699).Conclusion IOERT+CCRT yields a relatively favorable LC rate for unresectable locally advanced pancreatic cancer with low frequency of severe late toxicity,and IOERT combined with CCRT conferred a survival benefit compared with IOERT with chemotherapy.