Effect of Intraoperative Radiation Therapy (IORT) in Unresectable Pancreatic Cancer

PURPOSE: Pancreatic cancer is a devastating disease and the complete resection is difficult due to its the aggressive histologic behavior. Among the possible treatments for the unresectable pancreatic cancer, intraoperative radiation therapy (IORT) has the several advantages. But the impacts of the IORT on survival and local control are not clear. We analyzed the effects of the IORT on pain control, survival duration and local control in patients with unresectable pancreatic cancer. METHODS: We reviewed 6 years of the medical records of 94 patients who had undergone operations involving the pancreatic adenocarcinoma (33 patient IORTs, 39 palliative surgerys only and 22 curative resections involving a curative resection). The clinicopathologic factors and outcomes of the 33 patients treated with the IORT were compared with those of the palliative surgery groups. RESULTS: The age and sex distribution and tumor stage were same for the two groups. The average tumor size in the IORT group was larger than those of the palliative surgery group. The preoperative serum CA19-9 level in the IORT group was higher than the other group. The most common reason for unresectability in the IORT group was local invasion to the adjacent organs including of the great vessels. On the contrary, distant metastasis was a more common cause unresectability in the palliative surgery group. The postoperative complications and operative times were similar in both groups. Pain relief after treatment was observed in 12 cases of the 26 patients in the IORT group, and 5 of 29 patients in the palliative surgery group (P<0.05). The cases of minor and partial remission were more common in the IORT group than the palliative surgery group. However, the survival rate of the IORT group was no better than the palliative surgery group. CONCLUSION: This study suggests that IORT may have an important palliative role especially in ameliorating visceral pain in patients with unresectable pancreatic cancer. However, IORT appears to have no significant effect on overall survival.

Chronological Changes in the Clinical Features of Gastric Cancer

PURPOSE: Although gastric carcinomas occur throughout the world and the incidence is on the decrease, they remain the most common type of carcinoma in Korea. Significant advancements in the diagnostics and surgical treatment have been achieved during the last three decades. The present retrospective study was undertaken to investigate the chronological changes in the clinical features, including the clinicopathological findings, operative treatment, and the prognosis, of gastric carcinomas. METHODS: A total of 1973 patients with a primary gastric adenocarcinoma who had been treated surgically during the period from 1983 to 1998 at the Department of Surgery, Korea University College of Medicine, were divided into two groups in order to evaluate the chronological changes: 1,007 patients had been treated during the period from 1983 to 1992 (early period) and 966 patients during the period from 1993 to 1998 (late period). The chronological changes in age, sex, ratio of early gastric cancer (EGC), and resectability were analyzed in all 1973 cases. For the 1755 resected cases, we also studied the chronological changes in the clinicopathological and treatment factors between the early- period (n=894) and the late-period (n=867) groups. RESULTS: There were significant differences between the two periods with regard to age and ratio of EGC: EGC was more frequent in the late period. Univariate analysis of the resected cases showed that the gross type, tumor size, depth of invasion, UICC stage, and histological type were statistically significant. The analysis of the treatment factors revealed that total gastrectomies and extended lymphadenectomies were more frequent during the late period. The number of lymph nodes dissected was 26.0 12.7 in the early period and 33.4 14.1 in the late period (P<0.01). The 5-year survival rate in all cases was 51.4% in the early period and 55.9% in the late period. The stage-related survival rates (UICC 4th Ed., 1987) in the early vs. the late periods were 92.9% vs. 95.5% in stage IA, 82.1% vs. 91.1% in stage IB, 76.5% vs. 73.1% in stage II, 46.5% vs. 52.1% in stage IIIA, 14.5% vs. 33.6% in stage IIIB, and 2.8% vs. 8.8% in stage IV. There was a statistically significant difference in survival between stage IIIB and IV. CONCLUSION: These results suggest that the differences in the clinicopathological findings are related primarily to the increased number of early gastric cancer cases in the late period and that the improved survival noted during the late period for stage IIIB and IV cancers might be related to extended surgery.

Chronological Changes in the Clinical Features of Gastric Cancer

PURPOSE: Although gastric carcinomas occur throughout the world and the incidence is on the decrease, they remain the most common type of carcinoma in Korea. Significant advancements in the diagnostics and the surgical treatment of gastric carcinomas have been achieved during the last three decades. The present retrospective study was undertaken to investigate the chronological changes in the clinical features, including clinicopathological findings, operative treatment, and prognosis of gastric carcinomas. MATENRIALS AND METHODS: A total of 1973 patients with a primary gastric adenocarcinoma who had been treated surgically during the period from 1983 to 1998 at the Department of Surgery, Korea University College of Medicine, were divided into two groups to evaluate chronological changes: 1007 patients had been treated during the period from 1983 to 1992 (early period) and 966 patients during the period from 1993 to 1998 (late period). Chronological changes in age, sex, ratio of early gastric cancer (EGC), and resectability were analyzed in all 1973 cases. For the 1755 resected cases, we also studied the chronological changes in the clinicopathological and treatment factors between the early-period (n=894) and the late-period (n=867) groups. RESULTS: There were significant differences between the two periods with regard to age and ratio of EGC: EGC was more frequent in the late period. Univariate analysis of resected cases showed that gross type, tumor size, depth of invasion, UICC stage, and histological type were statistically significant. The analysis of the treatment factors revealed that total gastrectomies and extended lymphadenectomies were more frequent during the late period. The number of lymph nodes dissected was 26.0+/-12.7 in the early period and 33.4+/-14.1 in the late period (p<0.01). The 5-year survival rate in all cases was 51.4% in the early period and 55.9% in the late period. The stage-related survival rates (UICC 4th Ed., 1987) in the early vs. the late periods were 92.9% vs. 95.5% in stage IA, 82.1% vs. 91.1% in stage IB, 76.5% vs. 73.1% in stage II, 46.5% vs. 52.1% in stage IIIA, 14.5% vs. 33.6% in stage IIIB, and 2.8% vs. 8.8% in stage IV. There was a statistically significant difference in survival between stage IIIB and IV. CONCLUSION: These results suggest that the differences in the clinicopathological findings are related primarily to the increased number of early gastric cancer cases in the late period and that the improved survival noted during the late period for in stage IIIB and IV cancers might be related to extended surgery.