Using the New INTRABEAM Mobile Intraoperative Radiotherapy System During Surgery for Pancreatic Cancer

A Case Report

Xiaodong Song; Zili Shao; Huihong Liang

Disclosures

J Med Case Reports. 2019;13(23) 

In This Article

Abstract and Introduction

Abstract

Background: Pancreatic cancer is one of the most common fatal malignancies and has a poor prognosis. Surgical treatment is the most important treatment method, but there is a low rate of radical excision; moreover, the postoperative recurrence rate is high, with a local recurrence rate greater than 50%. The usefulness of intraoperative radiotherapy for pancreatic cancer has previously been examined. However, prior research was based on the traditional high-energy electron beam, which causes serious radiation toxicity. Therefore, the tumor radiation dose was limited, subsequently limiting the effect. In contrast, there is also a low-energy X-ray radiation system called INTRABEAM®. Use of INTRABEAM has been applied clinically, but the treatment effect of INTRABEAM in pancreatic cancer has not been reported.

Case presentation: We present a case of a 56-year-old Chinese man with local advanced pancreatic cancer with invasion of the coeliac trunk artery and origin of the portal vein. He underwent distal pancreatectomy and splenectomy along with intraoperative radiotherapy using a portable INTRABEAM radiation system. The radiotherapy dose was 10 Gy and irradiation time was 27.4 minutes. There were no obvious postoperative complications. His abdominal pain was alleviated after surgery, and no obvious tumor recurrence has been observed in short-term follow-up.

Conclusions: We believe that it is safe to apply intraoperative radiotherapy using the INTRABEAM radiation system in pancreatic cancer. This approach appears promising for further future development.

Introduction

Pancreatic cancer is the fourth leading cause of cancer-related death.[1] Surgical resection remains the mainstay therapy; however, less than 25% of patients have cancer that is resectable at the time of diagnosis.[2] Furthermore, approximately 50% of patients experience tumor recurrence after radical operation. It is believed that this high recurrence rate is associated with minimal residual disease along the border of the intact tissues that were not excised;[3,4] accordingly, intraoperative radiation therapy (IORT) has been used for patients with localized pancreatic cancer, including resectable or borderline resectable cases.[5,6] IORT has been used for decades in patients with pancreatic cancer, with the goal of pain reduction and control of locoregional tumor progression.[7,8] Formerly, IORT was performed with an electron energy source emitting a 6–20 MeV high-powered electron beam:[9] this produced promising results, but was prohibited by radiation-related complications.[10] Here, we describe a case in which we performed IORT with a low kV X-ray system called INTRABEAM® in a patient who underwent distal pancreatectomy to reduce the radiation-related complications and decrease the possibility of residual malignancy during the surgical resection. The low energy IORT system INTRABEAM provides low penetration and rapid attenuation of the radiation dose. We believed that it could eliminate the possible residual malignancies effectively and more safely than the traditional IORT.

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