Intraoperative radiotherapy in pancreatic cancer

Abstract

Radiation therapy (RT) is an important step of multimodal treatment for pancreatic cancer. Unfortunately, a multimodal therapy has not been able to improve pancreatic cancer patients' prognosis. Surgery remains the most important treatment, but only less then 15% of patients are candidates for potentially curative resection. The 5-year survival rate for pancreatic cancers is poor at less than 20%. Both adjuvant radiotherapy and chemotherapy have been shown to improve the survival, while neoadjuvant radiotherapy as well as intraoperative radiotherapy have also proposed to the improved prognosis..Intraoperative radiation therapy (IORT) is a very direct RT modality to deliver the irradiation for cancer involving upper abdominal structures and organs. IORT is a well-accepted approach in the clinical scenario (maturity and reproducibility of results), and extremely accurate in terms of dose-deposition characteristics and normal tissue sparing. The technique can be adapted to systemic therapy and surgical progress. International guidelines (National Comprehensive Cancer Network or NCCN guidelines) and ESTRO/ACROP currently recommend use of IORT in cases of close surgical margins and residual disease.