Improved survival and local control after intraoperative radiation therapy and postoperative radiotherapy - A multivariate analysis of 46 patients undergoing surgery for pancreatic head cancer

Hypothesis: Despite aggressive approaches, locoregional tumor control and survival rates for patients with cancer of the pancreatic head remain disappointing. In the present study, we address whether intraoperative and adjuvant radiotherapy may improve the prognosis for these patients. Design: A retrospective study. Setting: University hospital. Patients: From February 1985 to December 1995, 46 patients with an adenocarcinoma of the pancreatic head underwent pancreatic resection. The last 26 patients also received intraoperative radiotherapy (except 5 patients) and adjuvant external beam radiation therapy. Main Outcome Measures: Demographic data, tumor characteristics, surgical procedures, 5-year survival, and local control of disease were analyzed retrospectively. Results: The morbidity rate was not increased by adjuvant radiation therapy; it was 43% in patients treated with surgery alone and 57% in patients treated with surgery and radiotherapy (P=.1); operative mortality was 8% (n=2) and 9% (n=2), respectively (P=.8). Overall 5-year survival and local control were 13% and 48.6%, respectively. The mean+/-SD 5-year survival was 5.5%+/-5.3% (median, 10.8 months) in the surgery-alone group and 15.7%+/-8.6% (median, 14.3 months) in the surgery plus radiotherapy group (P=.06); local control at 5 years was 29.8% +/- 16.9% and 58.4%+/-19.9%, respectively (P<.01). Median metastasis-free survival was 8 and 9 months, respectively (P =.52). Multivariate analysis showed that adjuvant radiotherapy was an independent prognostic factor for survival (P<.01) and local control of the disease (P=.03). Conclusion: The present study supports the role of radiotherapy combined with pancreatoduodenectomy for treatment of cancer of the pancreatic head because even if the improvement in overall survival is moderate, it is effective in improving the local control of the tumor.