ABSTRACT
Objective To assess the prognostic benefits of intraoperative radiotherapy (IORT) with electron beam among patients with unresectable locally advanced pancreatic cancer.Methods Between January 2009 and December 2014,167 patients with unresectable locally advanced pancreatic cancer received IORT with electron beam (10-20 Gy) in our hospital.After surgery,12 patients were treated with external beam radiotherapy,56 patients with chemoradiotherapy (CRT),and 17 patients with chemotherapy.Overall survival (OS),local recurrence,and toxicities were retrospectively analyzed.The Kaplan-Meier method was used to calculate survival rates,the log-rank test was used for survival difference analysis and univariate prognostic analysis,and the Cox model was used for multivariate prognostic analysis.Results The follow-up rate was 100％.The median OS time was 10.3 months,and the 2-year OS rate was 22％.The median progression-fiee survival (PFS) time was 6.3 months,and the 2-year PFS rate was 9.9％.The cancer-specific survival (CSS) time was 11.2 months,and the 2-year CSS rate was 23.6％.In the patients treated with IORT alone at doses of＜15 Gy,15 Gy and＞15 Gy,the median OS times were 6.2 months vs.9.1 months vs.22.2 months,and the 1-year OS rates were 10.0％ vs.39.6％ vs.74.4％ (P=0.000).Among the patients receiving postoperative adjuvant therapy,those treated with IORT+CRT had the best survival,with a median OS time of 11.6 months (P=0.033).The univariate analysis showed that IORT dose (P =0.000),tumor size (P =0.006),and IORT applicator diameter (P =0.007) were prognostic factors.The multivariate analysis showed that IORT dose (P=0.000) and IORT combined with CRT (P=0.006) were independent prognostic factors.Conclusions IORT with electron beam is an effective and safe treatment strategy for unresectable locally advanced pancreatic cancer.After protecting surrounding organs,increasing the IORT dose can improve the survival.IORT combined with CRT should be recommended because it improves survival for unresectable locally advanced pancreatic cancer without increasing toxicities.
ABSTRACT
Objective To analyze the outcomes of radiotherapy for keloids by high energy electron beams and the factors influencing the treatment outcome.Methods From Jan 1998 to Jun 2012,846lesions in 578 patients received radiotherapy.The median age is 29 years old (range 5-80 years old).There are 841 lesions with postoperative radiotherapy and 39 lesions with skin-grafting.656 lesions treated within 1 day after operations.The max diameter of 348 keloids are ＞ 5 cm.We used 6 MeV and 7 MeV electron-beam radiation therapy.The total dose ranging from 16-18 Gy/2f (interval 1 week).Treatment fields including entire keloid scars,and any suture/puncture holes with a 1 cm-margin around the lesion were used.The skin grafting patients need radiotherapy after the flap survived (about 10-15 days after the operation).The median follow-up period was 36 months (range 8-185 months).Results There are 736 (87.0％) of 846 lesions with radiotherapy effective.Other 89 (10.5％) lesions relapse in 4-33 months (median 12 months).21 lesions were of no avail.The univarate analysis shows that keloids length,keloids location,skin-grafting,interval between operations and irradiations are the influencing factors of outcomes (P =0.007,0.000,0.000,0.001).The multivariate analysis shows that keloids location and skin-grafting remained statistically significant differences (P =0.001,0.001).Most of the recurrence cases are large and bent scars.Conclusions High-energy electron-beam radiotherapy for keloids can receive good outcomes.Treatment fields flat is very important for electron-beam radiotherapy.
ABSTRACT
Objective To evaluate the effcacy of electron-beam chest-wall irradiation in patients with breast cancer after mastectomy.Methods From June 1999 to December 2007,280 women with localized breast cancer received postmastectomy radiotherapy using electron beam to chest wall.The effcacy and toxicity of these 280 women was compared with 118 women treated during the same period using tangential field with photon beam.Results The follow-up rate was 93.2%.140 patients had a minimum followed up time of 5 years and 12 patients had a minimum follow up time of 10 years.The 5-year and 10-year chest wall recurrence rates were 6.8%and 5.0%.14.8%and 10.1%for patients irradiated with electron and photon(X2=1.12,P=0.290).The corresponding 5-year and 10-year disease-free survival rates were 60.6%and 65.5%,47.6%and 57.3%(X2=0.97,P=0.325).The 5-year and 10-year overall survival rates were 77.5%and 79.6%,48.4%and 53.3%(X2=0.37,P=0.545).Grade Ⅱ or more acute skin toxicity occurred in 10.4%and 16.9%of patients irradiated with electron and photon(X2=3.34.P=0.090).Pulmonary fibrosis developed in 28.8%and 22.1% of patients irradiated with electron and photon(X2=1.27,P=0.300).Conclusion Electron-beam chest-wall irradiation is as effective as photon-beam irradiation in breast cancer after mustectomy.