Orthovoltage intraoperative radiation therapy for pancreatic adenocarcinoma

Pavan Bachireddy, Diane Tseng, Melissa Horoschak, Daniel T. Chang, Albert C. Koong, Daniel S. Kapp, Phuoc T Tran

Research output: Contribution to journalArticle

Abstract

Purpose: To analyze the outcomes of patients from a single institution treated with surgery and orthovoltage intraoperative radiotherapy (IORT) for pancreatic adenocarcinoma.Methods: We retrospectively reviewed 23 consecutive patients from 1990-2001 treated with IORT to 23 discrete sites with median and mean follow up of 6.5 and 21 months, respectively. Most tumors were located in the head of the pancreas (83%) and sites irradiated included: tumor bed (57%), vessels (26%), both the tumor bed/vessels (13%) and other (4%). The majority of patients (83%) had IORT at the time of their definitive surgery. Three patients had preoperative chemoradiation (13%). Orthovoltage X-rays (200-250 kVp) were employed via individually sized and beveled cone applicators. Additional mean clinical characteristics include: age 64 (range 41-81); tumor size 4 cm (range 1.4-11); and IORT dose 1106 cGy (range 600-1500). Post-operative external beam radiation (EBRT) or chemotherapy was given to 65% and 76% of the assessable patients, respectively. Outcomes measured were infield control (IFC), loco-regional control (LRC), distant metastasis free survival (DMFS), overall survival (OS) and treatment-related complications.Results: Kaplan-Meier (KM) 2-year IFC, LRC, DMFS and OS probabilities for the whole group were 83%, 61%, 26%, and 27%, respectively. Our cohort had three grade 3-5 complications associated with treatment (surgery and IORT).Conclusions: Orthovoltage IORT following tumor reductive surgery is reasonably well tolerated and seems to confer in-field control in carefully selected patients. However, distant metastases remain the major problem for patients with pancreatic adenocarcinoma.

Original languageEnglish (US)
Article number105
JournalRadiation Oncology
Volume5
Issue number1
DOIs
StatePublished - Nov 8 2010

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Adenocarcinoma
Radiotherapy
Survival
Neoplasms
Neoplasm Metastasis
Pancreas
X-Rays
Radiation
Drug Therapy
Therapeutics

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

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Bachireddy, P., Tseng, D., Horoschak, M., Chang, D. T., Koong, A. C., Kapp, D. S., & Tran, P. T. (2010). Orthovoltage intraoperative radiation therapy for pancreatic adenocarcinoma. Radiation Oncology, 5(1), [105]. https://doi.org/10.1186/1748-717X-5-105

Orthovoltage intraoperative radiation therapy for pancreatic adenocarcinoma. / Bachireddy, Pavan; Tseng, Diane; Horoschak, Melissa; Chang, Daniel T.; Koong, Albert C.; Kapp, Daniel S.; Tran, Phuoc T.

In: Radiation Oncology, Vol. 5, No. 1, 105, 08.11.2010.

Research output: Contribution to journalArticle

Bachireddy, P, Tseng, D, Horoschak, M, Chang, DT, Koong, AC, Kapp, DS & Tran, PT 2010, 'Orthovoltage intraoperative radiation therapy for pancreatic adenocarcinoma', Radiation Oncology, vol. 5, no. 1, 105. https://doi.org/10.1186/1748-717X-5-105
Bachireddy P, Tseng D, Horoschak M, Chang DT, Koong AC, Kapp DS et al. Orthovoltage intraoperative radiation therapy for pancreatic adenocarcinoma. Radiation Oncology. 2010 Nov 8;5(1). 105. https://doi.org/10.1186/1748-717X-5-105
Bachireddy, Pavan ; Tseng, Diane ; Horoschak, Melissa ; Chang, Daniel T. ; Koong, Albert C. ; Kapp, Daniel S. ; Tran, Phuoc T. / Orthovoltage intraoperative radiation therapy for pancreatic adenocarcinoma. In: Radiation Oncology. 2010 ; Vol. 5, No. 1.
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AB - Purpose: To analyze the outcomes of patients from a single institution treated with surgery and orthovoltage intraoperative radiotherapy (IORT) for pancreatic adenocarcinoma.Methods: We retrospectively reviewed 23 consecutive patients from 1990-2001 treated with IORT to 23 discrete sites with median and mean follow up of 6.5 and 21 months, respectively. Most tumors were located in the head of the pancreas (83%) and sites irradiated included: tumor bed (57%), vessels (26%), both the tumor bed/vessels (13%) and other (4%). The majority of patients (83%) had IORT at the time of their definitive surgery. Three patients had preoperative chemoradiation (13%). Orthovoltage X-rays (200-250 kVp) were employed via individually sized and beveled cone applicators. Additional mean clinical characteristics include: age 64 (range 41-81); tumor size 4 cm (range 1.4-11); and IORT dose 1106 cGy (range 600-1500). Post-operative external beam radiation (EBRT) or chemotherapy was given to 65% and 76% of the assessable patients, respectively. Outcomes measured were infield control (IFC), loco-regional control (LRC), distant metastasis free survival (DMFS), overall survival (OS) and treatment-related complications.Results: Kaplan-Meier (KM) 2-year IFC, LRC, DMFS and OS probabilities for the whole group were 83%, 61%, 26%, and 27%, respectively. Our cohort had three grade 3-5 complications associated with treatment (surgery and IORT).Conclusions: Orthovoltage IORT following tumor reductive surgery is reasonably well tolerated and seems to confer in-field control in carefully selected patients. However, distant metastases remain the major problem for patients with pancreatic adenocarcinoma.

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