目的:對於局部侵犯相當嚴重或發生局部復發之腹部、骨盆腔內的惡性腫瘤而言，僅靠單一種治療方式要來達到長期的疾病控制及存活率是相當困難的。本研究主要是報告林口長庚醫院對於上述情況的腫瘤採用手術中放射治療的初步經驗。治療的方式。一類是針對原發但尚未經過其它方式治療的腫瘤{如胰臟癌、胃癌);另一類則是對復發的骨盆腔內腫瘤(如直腸癌、子宮頸癌)做救援性的治療。至1997年11月止，共治療了48位成人患者，年齡分布從32.4至75.7歲(中位數:60.5歲)。治療的患者計有19例胰臟癌、6例膽道癌、6例胃癌、9例大腸直腸癌、11例復發的空腸平滑肌肉瘤(jejunalleiomyosarcoma)、及7例復發的婦科惡性腫瘤。癌、及5例婦科惡性腫瘤。除了能夠接受骨盆腔器官全摘除的骨盆腔腫瘤之外，其它病例在手術中放射治療之時仍有殘留的腫瘤或甚至根本無法切除該腫瘤。74%之胰臟癌患者在術前因腫瘤壓迫到主動脈旁神經叢引起的極度疼痛在接受手術中放射治療之後即刻得到相當好的緩解。與手術中放射治療的高劑量有關之併發症至目前為止有1例發生(2%)。安全且可行的治療方式之一。手術中放射治療對於減輕胰臟腫瘤所引起的疼痛相當有效。進一步的評估須要更長時間的追蹤。

　　　　　Purpose: In patients with locally recurrent or advanced abdominal/pelvicmalignancies, long-term disease control and survival are difficult to achieve withsingle modality therapy. This report presents the preliminary results ofintraoperative radiotherapy (IORT) in our hospital.of the initial management in some previously untreated primary malignancies (e.g.,pancreatic carcinoma, gastric carcinoma) or part of the salvage or adjuvant treatmentin other malignancies (e.g., recurrent rectal or cervical cancer) since March 1996.Up to November 1997, 48 adult patients underwent this treatment modality with ageranging from 32.4 to 75.7 years old (median: 60.5). The malignancies treated by IORTconsisted of 19 pancreatic cancers, 6 cholangiocarcinomas, 6 gastric cancers, 9colorectal cancers, one case of recurrent jejunal leiomyosarcoma, and 7 gynecologiccancers.cancers, 4/6 cholangiocarcinoma, 3/6 gastric cancers, 8/9 colorectal cancers, 5/7gynecologic cancers). Except for some patients with pelvic malignancies receivingpelvic exenteration, all of the other patients had either gross residual orunresectable disease. Seventy-four percent of the patients with pancreatic cancersuffering from epigastralgia or back pain before treatment had achieved goodsymptomatic relief after surgery and IORT. IORT-related complications due to highdose irradiation occurred in two patients (4 %).modality for abdominal pelvic malignancies at high risk for local recurrence. It wasespecially effective in relieving tumor pain caused by pancreatic cancer. Longerfollow-up should be needed to evaluate the toxicity and efficacy of this approach.