Precision radiotherapy for cancer of the pancreas: Technique and results

doi:10.1016/0360-3016(80)90164-9

International Journal of Radiation OncologyBiologyPhysics

Volume 6, Issue 9, September 1980, Pages 1127-1133

https://doi.org/10.1016/0360-3016(80)90164-9 Get rights and content

Abstract

Forty patients with locally extensive, unresectable adenocarcinoma of the pancreas received precision high dose (PHD) radiation therapy with a 45 MeV betatron. A histologic diagnosis of cancer was established at laparotomy in every case. The gross margins of the tumor were outlined with radio-opaque clips in all but one case. The clipped tumor volume plus a 1 to 3 cm margin was irradiated to a minimum dose of 5900 to 7000 rad in 180 rad fractions over 7 to 9 weeks. For slender patients, a “mixed beam” technique was employed: opposed lateral 45-MeV photon beams mated to an anterior “mixed beam” consisting of 50 % 45-MeV photons and 50% 15–35 MeV electrons. The choice of electron energy depended upon the depth of the posterior margin of the target volume. For non-slender patients, a “box” technique consisting of 3 or 4 fields of 45-MeV photons was used. Where indicated, fields were shaped to conform the isodose distribution to the shape of the target volume. PHD radiotherapy was generally well tolerated. During !treatment, only 7 patients experienced significant nausea, vomiting, diarrhea or anorexia. Late gastrointestinal radiation reactions were observed in 7 patients (severe in 3 patients). Twelve patients received adjuvant chemotherapy. Relief of pain occurred in $2232$ patients and anorexia improved in $815$ patients following PHD radiotherapy. The projected survival of patients with unresectable pancreatic cancer treated with PHD radiotherapy is comparable to that of patients with resectable disease operated on for cure. The projected one year survival rate is 49%.

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Citation Excerpt :
Radiation was delivered in 1.8-Gy fractional doses over 7 to 9 weeks to yield tumor doses of 60 Gy to 70 Gy. This new technique allowed for greatly increased patient tolerance.19 Intraoperative radiation therapy (IORT) has been used with varying degrees of enthusiasm for nearly 30 years.
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^☆: Supported, in part, by U.S. Public Health Service Grants CA-09137 and CA-11602 from the National Cancer Institute, U.S. Department of Health, Education and Welfare and by Grants JCFC 26313 and C'F4199 from the American Cancer Society.

^☆☆: Presented at the 20th annual meeting of the American Society of Therapeutic Radiologists, Los Angeles, California, November 1–4, 1978.

¹: Associate Professor.

²: Chief Resident.

⁵: Present address: Department of Radiation Therapy, M.D. Anderson Hospital, 6723 Bertner Avenue, Houston Texas 77025.

³: Assistant Professor.

⁴: Professor.

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Original contributionPrecision radiotherapy for cancer of the pancreas: Technique and results☆,☆☆

Abstract

Am. J. Surg.

Calculation of survival rates for cancer

A study of radiation therapy in carcinoma of the pancreas

The radiotherapy of pancreatic cancer

Sem. Oncol.

Pancreatic carcinoma treated with highdose, small-volume irradiation

Cancer

Treatment of cancer of the pancreas with high-energy photons and electrons

Int. J. Radiat. Oncol. Biol. Phys.

Pancreatic cancer and its treatment by implanted radium

Ann. Surg.

Original contribution
Precision radiotherapy for cancer of the pancreas: Technique and results☆,☆☆