The addition of intraoperative radiotherapy (IORT) to intensive neoadjuvant chemotherapy and chemoradiotherapy was associated with encouraging survival rates without increased toxicity in patients with pancreatic adenocarcinoma who have close/positive margins and in those with unresectable disease, according to a study published in the American Journal of Clinical Oncology.1

The use of FOLFIRINOX (fluorouracil, leucovorin, irinotecan, oxaliplatin) or gemcitabine plus nab-paclitaxel has improved outcomes for patients with metastatic pancreatic adenocarcinoma, prompting incorporation of these regimens into neoadjuvant therapy of locally advanced unresectable disease.

Upon surgical exploration, some patients’ tumors remain unresectable, while others are able to undergo resection of the tumor following intensive neoadjuvant therapy. Researchers therefore assessed the outcomes and safety associated with IORT in combination with resection or exploratory laparotomy after intensive neoadjuvant chemotherapy and chemoradiotherapy.

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Investigators retrospectively analyzed data from 68 patients with locally advanced unresectable or borderline-resectable pancreatic adenocarcinoma who underwent intensive neoadjuvant induction chemotherapy and chemoradiotherapy followed by exploratory laparotomy and IORT.

Of those, 60.3% underwent resection, 26.5% had unresectable disease, and 13.2% had distant metastases. Of the 41 patients who underwent resection, 22 received IORT for close/positive resection margins.

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The study showed no significant difference in median overall survival among patients who underwent resection, patients who underwent resection and IORT, and those who underwent resection alone; median overall survival was 26.6, 35.1, and 24.5 months, respectively.

A prospective study is needed to confirm these results and to determine the relationship between adding IORT and survival in this population.


  1. Keane FK, Wo JY, Ferrone CR, et al. Intraoperative radiotherapy in the era of intensive neoadjuvant chemotherapy and chemoradiotherapy for pancreatic adenocarcinoma. Am J Clin Oncol. 2016 Oct 12. doi: 10.1097/COC.0000000000000336 [Epub ahead of print]