Is the long-term survival rate improved by preoperative irradiation prior to Whipple's procedure for adenocarcinoma of the pancreatic head?
O. Ishikawa, H. Ohigashi, S. Imaoka, Y. Sasaki, T. Iwanaga, Y. Matayoshi and T. Inoue
Department of Surgery, University of Osaka, Japan.
OBJECTIVE: To determine whether or not both regional control and long-term
survival rate were improved by preoperative irradiation prior to curative
pancreatectomy for adenocarcinoma of the pancreatic head. DESIGN:
Retrospective study of recorded medical data from 1985 to 1989. SETTING:
The Center for Adult Diseases, Osaka, one of the major cancer centers in
Japan. PATIENTS AND INTERVENTION: Fifty-four consecutive patients in whom
pancreatic head cancer had been judged to be resectable by preoperative
diagnostic techniques. A total of 50 Gy per 10 MeV of x-ray was irradiated
preoperatively to the wide field, including the pancreatic head area, in 23
patients (group A) but not in the 31 remaining patients (group B). The
background factors before treatment did not differ between these two
groups. OUTCOME MEASURES: Resectability, postoperative survival, and modes
of cancer recurrence. RESULTS: At laparotomy, curative pancreatectomy was
possible in 17 patients (74%) in group A and 19 (61%) in group B (not
significant). In patients undergoing resection, the 1-year survival rate
was 75% in group A and 43% in group B (P < .05). However, 3- and 5-year
survival rates were almost the same in both groups (28% vs 32% and 22% vs
26%, respectively). With regard to the cause of death after pancreatectomy,
group A had a significantly lower incidence of deaths due to regional
recurrence within 1.5 postoperative years compared with group B, whereas
deaths due to hepatic metastasis were markedly higher after 1 postoperative
year in group A compared with group B. CONCLUSIONS: Preoperative
irradiation prior to pancreatectomy succeeded in reducing the incidence of
early deaths due to regional recurrence. However, owing to the next
barrier--death due to hepatic metastasis after 1 postoperative
year--long-term (3- and 5-year) survival rate was not improved at all.
