External beam plus intraoperative irradiation for gastrointestinal cancers

Leonard L. Gunderson, David M. Nagorney, James A. Martenson, John H. Donohue, Gracila R. Garton, Heidi Nelson, Jennifer Fieck

Research output: Contribution to journalArticle

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Abstract

Although useful palliation can often be achieved when external beam irradiation and chemotherapy are used to treat locally advanced gastrointestinal malignancies, local control and long-term survival are infrequent in view of the limited tolerance of surrounding organs and tissues. In view of dose limitations of external beam irradiation, intraoperative irradiation (IORT) with electrons has been used as a supplement to external treatment in an attempt to improve the therapeutic ratio of local control versus complications. An IORT dose of 10 to 20 Gy has been combined with fractionated external beam doses of 45 to 55 Gy in 1.8 Gy fractions in studies performed in the United States, Japan, Europe, and Scandinavian countries. In this paper the indications for and the results of aggressive combined techniques that include IORT are discussed. Results obtained with external beam techniques alone or with chemotherapy and resection are presented by site to demonstrate the need for higher doses of irradiation. When results from IORT series are compared to standard treatment with regard to disease control and survival, local control appears better with locally advanced colorectal, gastric, and pancreatic cancer; and survival appears better with colorectal ± biliary cancers. With pancreatic cancer, improvements in local control do not translate into increased survival in view of the high incidence of subsequent liver and peritoneal failures. Implications for future strategies in all sites are discussed.

Original languageEnglish (US)
Pages (from-to)191-197
Number of pages7
JournalWorld Journal of Surgery
Volume19
Issue number2
DOIs
StatePublished - Mar 1995

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Gastrointestinal Neoplasms
Pancreatic Neoplasms
Colorectal Neoplasms
Biliary Tract Neoplasms
Drug Therapy
Liver Failure
Stomach Neoplasms
Japan
Therapeutics
Electrons
Incidence
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

Gunderson, L. L., Nagorney, D. M., Martenson, J. A., Donohue, J. H., Garton, G. R., Nelson, H., & Fieck, J. (1995). External beam plus intraoperative irradiation for gastrointestinal cancers. World Journal of Surgery, 19(2), 191-197. https://doi.org/10.1007/BF00308625

External beam plus intraoperative irradiation for gastrointestinal cancers. / Gunderson, Leonard L.; Nagorney, David M.; Martenson, James A.; Donohue, John H.; Garton, Gracila R.; Nelson, Heidi; Fieck, Jennifer.

In: World Journal of Surgery, Vol. 19, No. 2, 03.1995, p. 191-197.

Research output: Contribution to journalArticle

Gunderson, LL, Nagorney, DM, Martenson, JA, Donohue, JH, Garton, GR, Nelson, H & Fieck, J 1995, 'External beam plus intraoperative irradiation for gastrointestinal cancers', World Journal of Surgery, vol. 19, no. 2, pp. 191-197. https://doi.org/10.1007/BF00308625
Gunderson LL, Nagorney DM, Martenson JA, Donohue JH, Garton GR, Nelson H et al. External beam plus intraoperative irradiation for gastrointestinal cancers. World Journal of Surgery. 1995 Mar;19(2):191-197. https://doi.org/10.1007/BF00308625
Gunderson, Leonard L. ; Nagorney, David M. ; Martenson, James A. ; Donohue, John H. ; Garton, Gracila R. ; Nelson, Heidi ; Fieck, Jennifer. / External beam plus intraoperative irradiation for gastrointestinal cancers. In: World Journal of Surgery. 1995 ; Vol. 19, No. 2. pp. 191-197.
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