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Intraoperative Radiation Treatment

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Hepato-Pancreato-Biliary Malignancies

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Abstract

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal cancers. To achieve long-term survival, surgical resection is essential in the treatment paradigm. However, local tumor recurrence remains high even after curative resection with negative margins (R0), suggesting undetected microscopic margin involvement. Given high local failure rates, techniques to escalate radiation doses have been investigated. One of these strategies is intraoperative radiation therapy (IORT), which was developed to deliver a higher radiation dose to the tumor bed than traditional external beam radiotherapy (EBRT) while sparing adjacent normal tissues. This technique can improve local control when combined with EBRT in resectable, borderline resectable, and locally advanced PDAC patients. In the modern era of neoadjuvant therapy, studies have also demonstrated improved survival rates in patients who receive intensive neoadjuvant chemotherapy, followed by chemoradiation therapy and IORT at the time of resection, without increased toxicity. IORT seems to be a robust therapeutic adjunct when treating pancreatic cancer patients.

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Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Yurie Sekigami, Theodoros Michelakos & Cristina Ferrone

Authors
  1. Yurie Sekigami
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  2. Theodoros Michelakos
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  3. Cristina Ferrone
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Correspondence to Cristina Ferrone .

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Editors and Affiliations

  1. Medical Director, Capital Health Medical Center Hopewell, Pennington, NJ, USA

    Cataldo Doria

  2. Capital Health Center for Digestive Health, Pennington, NJ, USA

    Jason N. Rogart

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Sekigami, Y., Michelakos, T., Ferrone, C. (2021). Intraoperative Radiation Treatment. In: Doria, C., Rogart, J.N. (eds) Hepato-Pancreato-Biliary Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-030-37482-2_33-1

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  • DOI: https://doi.org/10.1007/978-3-030-37482-2_33-1

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  • Print ISBN: 978-3-030-37482-2

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