The Munich experience in intraoperative irradiation therapy of pancreatic cancer

Eighteen patients with locally unresectable pancreatic cancer without distant metastases were treated by IORT and in part bypass surgery. IORT dose was 15-20 Gy, 13 patients received additionally 50 Gy external beam irradiation over 5 1/2 weeks, further 5 patients 34 Gy external beam irradiation + 5-FU. Median survival was 8 months, no patient survived longer than 14 months. Cause of death were distant failure in 9 patients, complications in 5 patients, other reasons in 3 patients. Because of the high rate of patients, who had an impressive pain relief immediately after IORT (82% free of pain without or with mild drugs only) over a period of 4 months, the indication was extended for IORT to patients with distant metastases (n = 11), who demonstrated similar effects. Local control for the whole patient collective (n = 29) was 75%. For that reason IORT is used also for tumor bed irradiation after radical resection of pancreatic carcinoma