Combined Intraoperative Radiotherapy (IORT) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) with Cytoreduction Surgery (CRS) as a Novel Approach in the Management of Resectable Pancreatic Cancer.
Ayman Azzam, Tarek Amin
Abstract
BACKGROUND: Pancreatic cancer is leading cause of cancer related deaths. The prognosis is usually very poor. In spite of the advances in modern surgery, the outcome is still poor. IORT was recently introduced with recorded improvement in both locoregional tumor control and patient survival. Prophylactic HIPEC was introduced during the initial surgery in order to prevent subsequent peritoneal cancer or tumor recurrence which showed some encouraging results. AIM OF WORK: Evaluation of the perioperative results of the combination of IORT and HIPEC with CRS as a novel approach in the management of resectable pancreatic cancer. PATIENTS AND METHODS: This study was conducted at King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia. Data were collected retrospectively. A total of five patients were included in the study, during the period from November 2017 to August 2018. All surgeries were done by the same surgeon. RESULTS: The average age was 51 years (25-63). The patients were two males and three females. All the patients underwent complete surgical resection combined with IORT then HIPEC. All patients were discharged home in good condition. They were regularly followed up without any evidence of local recurrence or metastases. CONCLUSION: The combination of IORT and HIPEC with CRS gives the addition of the benefits of each procedure alone without affecting the postoperative morbidity or mortality. This combination appeared to be feasible, safe and well tolerated. However, this need to be applied on a larger number of patients with longer periods of follow-up to reach sound conclusions.