RT Journal Article
SR Electronic
T1 Safety and efficacy of intraoperative radiation therapy using a low-energy X-ray source for resectable pancreatic cancer: an interim evaluation of an ongoing prospective phase II study
JF Cancer Biology & Medicine
JO Cancer Biology & Medicine
FD China Anti-Cancer Association
SP 67
OP 76
DO 10.20892/j.issn.2095-3941.2024.0287
VO 22
IS 1
A1 Chen, Xingyun
A1 Li, Shuo
A1 Gao, Chuntao
A1 Wang, Wei
A1 Li, Haorui
A1 Liu, Yuxiao
A1 Liu, Rui
A1 Hao, Jihui
YR 2025
UL http://www.cancerbiomed.org/content/22/1/67.abstract
AB Objective: The role of intraoperative radiation therapy (IORT) in the management of resectable pancreatic cancer (RPC) remains unclear. To date, the application of IORT using a low-energy X-ray source has not been extensively investigated. Therefore, this study was conducted to evaluate the safety and efficacy of IORT using a 50 kV X-ray source in treating RPC.Methods: Patients with RPC who underwent radical pancreatectomy and IORT were enrolled. The primary endpoint was time to treatment failure (TTF) survival, whereas the secondary endpoints were safety and overall survival (OS).Results: By November 2023, 35 patients with RPC were treated according to the study protocol. The median TTF was 11.67 months, whereas the median OS for the cohort was 22.2 months. The local recurrence rate was 20%. The most common postoperative complication was pancreatic fistula. The incidence of delayed gastric emptying was 20%. Within 30 days after surgery, one patient experienced abdominal pain, another experienced vomiting, and one died because of abdominal infection and a grade C pancreatic fistula. Carcinoembryonic antigen (CEA) and D-dimer levels significantly correlated with TTF and OS in multivariate analyses. The carbohydrate antigen 19-9 (CA19-9) level was another prognostic factor significantly associated with OS. Patients with low D-dimer and normal CA19-9 levels showed prolonged OS with an IORT dose ≤ 15 Gy.Conclusions: This study supports use of IORT with a 50 kV X-ray source in treating RPC. IORT using a low-energy X-ray source was well-tolerated and feasible. Additionally, D-dimer, CEA, and CA19-9 levels may help identify patient profiles potentially benefitting from IORT.The data generated in this study are available upon request from the corresponding author.