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Intraoperative radiotherapy for pancreatic cancer — Requiem or revival?
Inr. J. Radiarion Oncology Bzol. Phys.. Vol. 21, P. 1389 Prmted in the U.S.A. All nghts reserved
Copyright
0360.3016191 $3.00 + 00 0 199, Pergamon Press plc
??Editorial
INTRAOPERATIVE PANCREATIC CANCER
RADIOTHERAPY FOR - REQUIEM OR REVIVAL?
ALFRED L. GOLDSON, M.D.,
F.A.C.R.
Radiation Oncology, Howard University Hospital, Washington,
D.C. 20060
study, in my opinion, was well designed and user friendly. It combined the logic of using IORT as a safe “boost” dose, fractionated external beam irradiation to cover the entire pancreas and regional lymphatics, and I.V. 5-FU, a proven gastrointestinal tract chemotherapeutic agent for systemic coverage. The poor outcome only reflected the aggressive and insidious nature of pancreatic cancer. To shake our heads and close the chapter on IORT for pancreatic cancer at this point would be premature; other combinations should be evaluated. Don’t our medical oncology colleagues just rearrange the alphabetical order of their drug combinations and proceed to enter more patients onto protocol? Why shouldn’t we? At Howard University Hospital, we are performing a Phase I/II study combining the simultaneous delivery of IORT electrons with interstitial intraoperative hyperthermia followed by fractionated external beam irradiation (3). Initial findings show an improvement in median survival for this new protocol group over our previous group that received IORT plus external beam irradiation. Additional studies should consider combinations of IORT with Iodine- 125 seeds, Ferromagnetic seeds, monoclonal antibodies, and aggressive chemotherapy regimens. Now is the time to recall the troops and plan another attack.
From Whipple resection to RTOG-8505 Phase I/II intraoperative radiotherapy (IORT) study, the outlook for cure of adenocarcinoma of the pancreas has remained dismal. Modem day IORT enthusiasts looked to IORT as a possible ray of hope because of its unique application and because previous techniques using combinations of external beam irradiation, interstitial implants, plus or minus chemotherapy, had improved median survival of patients treated by by-pass procedures alone by only three to seven months. Early IORT techniques reported by Abe (1) and Goldson (2) using single doses of 2040 Gy alone produced six month median survival rates. The initial reports from Massachusetts General Hospital and the Mayo Clinic, using IORT as a “boost” dose in combination with external beam irradiation, gave some sense of promise with median survivals for unresectable pancreatic tumors of 13.5 months (4). Similar studies from other centers in Japan and the United States were not as good, with median survivals closer from eight to nine months. The RTOG-8505 Phase I/II IORT study for pancreatic cancer was supposed to set the numbers straight and confirm, in a multi-institutional study, that there was some improvement in median survival. Unfortunately, the study only demonstrated the feasibility of the technique and the acceptable morbidity, but no improvement in survival. The
REFERENCES 1. Abe, M.; Takahashi, M. Intraoperative radiotherapy - the Japanese experience. Int. J. Oncol. Biol. Phys. 7:863-868. 1981. 2. Goldson, A.; Ashayeri, E.; Espinoza, M., et al. Single dose intraoperative electrons for advanced stage pancreatic cancer: Phase I pilot study. Int. J. Radial Oncol. Biol. Phys. 7:869874; 1981. 3. Goldson, A.; Smyles, J.; Ashayeri, E., et al. Simultaneous Accepted
for publication
intraoperative radiation therapy and intraoperative interstitial hyperthermia for unresectable adenocarcinoma of the pantreas. Endocurie therapyMyperthermia Oncology. 3:201-208; 1987. 4. Tepper, J.; Shipley, W.; Warshaw, A., et al. The role of Misonidazole combined with intraoperative radiation therapy in the treatment of pancreatic cancer. J. Clin. Oncol. 5579-584; 1987.
19 August 1991.
1389
Copyright
0360.3016191 $3.00 + 00 0 199, Pergamon Press plc
??Editorial
INTRAOPERATIVE PANCREATIC CANCER
RADIOTHERAPY FOR - REQUIEM OR REVIVAL?
ALFRED L. GOLDSON, M.D.,
F.A.C.R.
Radiation Oncology, Howard University Hospital, Washington,
D.C. 20060
study, in my opinion, was well designed and user friendly. It combined the logic of using IORT as a safe “boost” dose, fractionated external beam irradiation to cover the entire pancreas and regional lymphatics, and I.V. 5-FU, a proven gastrointestinal tract chemotherapeutic agent for systemic coverage. The poor outcome only reflected the aggressive and insidious nature of pancreatic cancer. To shake our heads and close the chapter on IORT for pancreatic cancer at this point would be premature; other combinations should be evaluated. Don’t our medical oncology colleagues just rearrange the alphabetical order of their drug combinations and proceed to enter more patients onto protocol? Why shouldn’t we? At Howard University Hospital, we are performing a Phase I/II study combining the simultaneous delivery of IORT electrons with interstitial intraoperative hyperthermia followed by fractionated external beam irradiation (3). Initial findings show an improvement in median survival for this new protocol group over our previous group that received IORT plus external beam irradiation. Additional studies should consider combinations of IORT with Iodine- 125 seeds, Ferromagnetic seeds, monoclonal antibodies, and aggressive chemotherapy regimens. Now is the time to recall the troops and plan another attack.
From Whipple resection to RTOG-8505 Phase I/II intraoperative radiotherapy (IORT) study, the outlook for cure of adenocarcinoma of the pancreas has remained dismal. Modem day IORT enthusiasts looked to IORT as a possible ray of hope because of its unique application and because previous techniques using combinations of external beam irradiation, interstitial implants, plus or minus chemotherapy, had improved median survival of patients treated by by-pass procedures alone by only three to seven months. Early IORT techniques reported by Abe (1) and Goldson (2) using single doses of 2040 Gy alone produced six month median survival rates. The initial reports from Massachusetts General Hospital and the Mayo Clinic, using IORT as a “boost” dose in combination with external beam irradiation, gave some sense of promise with median survivals for unresectable pancreatic tumors of 13.5 months (4). Similar studies from other centers in Japan and the United States were not as good, with median survivals closer from eight to nine months. The RTOG-8505 Phase I/II IORT study for pancreatic cancer was supposed to set the numbers straight and confirm, in a multi-institutional study, that there was some improvement in median survival. Unfortunately, the study only demonstrated the feasibility of the technique and the acceptable morbidity, but no improvement in survival. The
REFERENCES 1. Abe, M.; Takahashi, M. Intraoperative radiotherapy - the Japanese experience. Int. J. Oncol. Biol. Phys. 7:863-868. 1981. 2. Goldson, A.; Ashayeri, E.; Espinoza, M., et al. Single dose intraoperative electrons for advanced stage pancreatic cancer: Phase I pilot study. Int. J. Radial Oncol. Biol. Phys. 7:869874; 1981. 3. Goldson, A.; Smyles, J.; Ashayeri, E., et al. Simultaneous Accepted
for publication
intraoperative radiation therapy and intraoperative interstitial hyperthermia for unresectable adenocarcinoma of the pantreas. Endocurie therapyMyperthermia Oncology. 3:201-208; 1987. 4. Tepper, J.; Shipley, W.; Warshaw, A., et al. The role of Misonidazole combined with intraoperative radiation therapy in the treatment of pancreatic cancer. J. Clin. Oncol. 5579-584; 1987.
19 August 1991.
1389