Carcinoma of the pancreas: Results of the conventional irradiation for unresectable lesions

Operative finding, treatment, and prognosis of carcinoma of the pancreas: an analysis of 267 cases

Two hundred sixty-seven laparotomized patients with pancreatic cancer during the period 1947 to 1980 were retrospectively analyzed. In 199 histologically confirmed cases of pancreatic carcinoma the tumor was only local with no invasion to neighboring tissues or distant metastases in 15% of the cases at the primary laparotomy and diagnosis stages, and the survival rates after 1, 3, and 5 years were 22%, 3% and 1%, respectively. The prognosis was a little better if a patient was over 70 years old, duration of symptoms was more than one year, the reason for laparotomy was cholecystopathy, the tumor was stage I, the treatment was a combination therapy of pancreatic resection and postoperative irradiation (with a depth dose of greater than or equal to 4,000 rad). We concluded that, excluding the extremely rare cases of pancreatic carcinoma which are cured with pancreatic resection, the survival of patients after primary operation is correlated nearly in the same way with the given treatment and the stage of the disease. It seems that at present the only possibility of improving the results of treatment in pancreatic carcinoma is to develop the combined treatment of surgery, irradiation, and chemotherapy.

Current radiotherapeutic approaches to pancreatic cancer

Adenocarcinoma of the pancreas is not a radioresistant neoplasm, as was once believed. The data now suggest that in some instances this cancer may be radiocurable. This fact seems to justify the risk of pancreatic biopsy even in the face of unresectable disease, for it is well known that many benign conditions imitate pancreatic cancer. Clinical benefit from radiation for pancreatic cancer treatment is dose related. Careful delineation of tumor margins, precision treatment planning, and precision dose delivery can minimize damage to adjacent normal tissues. Interstitial implantation and intraoperative electron beam therapy are being studied as methods of accurate dose delivery for pancreatic cancer. Fractionation studies and high LET studies are in embryonic stages. Combined modality regimens may have much to offer in terms of improved palliation and survival for patients with localized adenocarcinoma of the pancreas.