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Iort Procedure

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The remaining patients are alive without evidence of recurrence on follow-up. Follow up period from 6-41 months with an overall free survival rate of 66.6%.

IORT was first discovered in Japan during 1970s. It was applied in patients with locally advanced malignancies (10). It involves the application of radiation beam from the radiation machine in the operative field after tumor resection, directly on the suspected tissues after exposure. This procedure guarantee the administration of high doses of radiation to the affected areas. This increases the chance of killing the tumor cells remaining after surgical resection. The unaffected tissues can be shielded or placed away from the radiation beam which decreases the risk of radiation complications on these organs (11). The earlier studies performed to evaluate the effect of IORT on the affected patients concluded that it is of great benefit for both local disease control and longer disease free survival (12, 13). This was applicable for resectable pancreatic and periampullary adenocarcinoma. Also, in cases of unresectable tumors, IORT has the advantages of controlling the disease locally and minimizing tumor pain (14).

Most of the studies regarding the effect of IORT after complete resection of pancreatic and periampullary cancer are retrospective studies (15-18). Many studies have evaluated the results in patients who have undergone complete surgical resection combined with IORT and who had surgical resection alone(4). These studies showed the reduction of local recurrence in the patient received IORT than in patients who did not receive IORT (4). Zerbi et al. (15) compared patients who had complete surgical resection and receive IORT and patients who underwent resection alone.

They found that there is no differences between the two groups regarding both operative mortality and early postoperative complications. Regarding tumor recurrence, they found that it was 56% in the group who had surgery alone and 26% in the group who had complete surgical resection combined with IORT. Reni et al.(16) studied 127 patients who had complete surgical resection combined with IORT and compared these patients with 76 patients with had complete surgical resection alone. They did not find any difference in operative morbidity and mortality due to the application of IORT. Moreover, they found that the application of IORT in patients with stage I and II cancer significantly delays the local recurrence and prolongs the overall survival. Another 2 different larger studies proved the benefit of the IORT in the local control of the tumor without any increase in both operative morbidity and mortality (17, 18). Based on these reviews, we added IORT as part of the management of pancreatic and periampullary cancers. Our results were in agreement with most of the studies performed to investigate the role of IORT in the management of pancreatic and periampullary adenocarcinoma.

IORT is a feasible and safe procedure. It is well tolerated and does not increase both the operative morbidity and mortality the treated patients. Although our results are favorable, however, a larger number of patients will be needed to get a clear conclusion.

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