Intraoperative irradiation combined with radical resection for cancer of the head of the pancreas

Since December, 1976, intraoperative irradiation combined with resection for cancer of the head of the pancreas has been used in our clinic to prevent local recurrence. Thirty Gy of the electron beam from a linear accelerator were administered to the operative field including the celiac axis and mesenteric artery following pancreaticoduodenectomy. Results of the combined therapy in 12 patients were compared to results in 12 patients who underwent pancreaticoduodenectomy alone. The combined therapy group compared to pancreaticoduodenectomy alone showed improvement in the 1‐year survival rate, but not in the 2‐year survival rate. Autopsy of 3 paients who underwent the combined therapy did not reveal any involvement of the lymph nodes in the irradiation field. However, there was involvement of the lymph nodes around the aorta from the diaphragm above to the inferior mesenteric artery below (except in the irradiation field). Additionally, there were metastases to the liver in all autopsied patients and recurrence in the pancreatic remnant in 1 patient. In spite of the local effect of irradiation therapy, there was no prolongation of survival. These results suggest that treatment for carcinoma of the head of the pancreas should be intensified toward liver metastases and the lymph nodes around the aorta from the diaphragm above to the inferior mesenteric artery below.