Clinical problems in radiotherapy of carcinoma of the pancreas *

Abstract

Since 1975, 94 patients with localized unresectable carcinoma of the pancreas have been irradiated using He and heavier particles at the University of California Lawrence Berkeley Laboratory [San Francisco, California, USA]. Despite surgical exploration and an extensive diagnostic work-up including radiological, nuclear medicine and computer-assisted tomographic studies, many patients proved to have occult liver metastases manifested within 9 mo. post-treatment. Local and regional control of the primary neoplasm (.apprx. 20%) was difficult to obtain even with doses of 6000 equivalent rad in 7 1/2 wk. Gastric and biliary obstruction required surgical bypass procedures since irradiation was not successful in relieving obstructive symptoms. Evidence of gastrointestinal injury was present in postradiation therapy in .apprx. 10% of patients, a figure which might be higher if more patients had a longer survival (average 10 mo.). Some patients require pancreatic enzyme supplementation because of pancreatic deficiency secondary to tumor or treatment. Further improvement in local control and survival requires better diagnostic methods for evaluation of local and metastatic spread, improved therapy for local and regional disease and therapy directed at occult liver metastases that are frequently present.