Sun S, Xu H, Xin J, Liu J, Guo Q, Li S
Endoscopy Center, Second Hospital of China Medical University, Shenyang, Province, China.
Endoscopy. 2006 Apr;38(4):399-403. doi: 10.1055/s-2006-925253.
Intraoperative interstitial brachytherapy has been found to be effective when used during laparotomy to improve local control in patients with locally advanced pancreatic cancer. In this study, we report the results of using endoscopic ultrasound- (EUS-)guided interstitial brachytherapy in patients with advanced pancreatic cancer, with respect to tumor response, clinical response, safety, and complications.
Fifteen patients (eight men, seven women; median age 61 years) with unresectable pancreatic adenocarcinoma were enrolled into the study, eight patients with stage III disease and seven patients with stage IV disease. A mean number of 22 radioactive seeds per patient were implanted into the tumors by EUS-guided needle puncture. The mean total implanted activity was 20 mCi, the minimum peripheral dose was 14,000 cGy, and the mean volume of implants was 52 cm3. Patients were followed-up by examination and by imaging tests every 2-3 months: clinical end points included the Karnofsky performance status and pain responses, tumor response (assessed by computed tomography and/or EUS), and survival.
During a median follow-up period of 10.6 months, the objective tumor response was classified as "partial" in 27% of patients (with a median duration of partial response of 4.5 months), "minimal" in 20% patients, and indicative of "stable disease" in 33% of patients. Clinical benefit was shown in 30% of patients, mostly due to reduction in pain, but this lasted for a limited time. Local complications (pancreatitis and pseudocyst formation) occurred in three patients; grade III hematologic toxicity occurred in three patients without serious clinical sequelae.
EUS-guided intraoperative interstitial brachytherapy had a moderate local tumor effect and showed some clinical benefit in 30% of the patients in this study. Combination of this form of treatment with external radiation and/or chemotherapy should be tested in future trials.
术中组织间近距离放射治疗已被发现在剖腹手术中用于改善局部晚期胰腺癌患者的局部控制时是有效的。在本研究中，我们报告了使用内镜超声（EUS）引导下组织间近距离放射治疗晚期胰腺癌患者的结果，涉及肿瘤反应、临床反应、安全性和并发症。
15例无法切除的胰腺腺癌患者（8例男性，7例女性；中位年龄61岁）纳入本研究，8例为Ⅲ期疾病患者，7例为Ⅳ期疾病患者。通过EUS引导下的针穿刺，平均每位患者向肿瘤内植入22颗放射性粒子。平均总植入活度为20毫居里，最小周边剂量为14000厘戈瑞，平均植入体积为52立方厘米。每2 - 3个月通过检查和影像学检查对患者进行随访：临床终点包括卡氏功能状态评分和疼痛反应、肿瘤反应（通过计算机断层扫描和/或EUS评估）以及生存率。
在中位随访期10.6个月期间，27%的患者客观肿瘤反应分类为“部分缓解”（部分缓解的中位持续时间为4.5个月），20%的患者为“微小缓解”，33%的患者显示为“疾病稳定”。30%的患者显示出临床获益，主要是由于疼痛减轻，但持续时间有限。3例患者出现局部并发症（胰腺炎和假性囊肿形成）；3例患者出现Ⅲ级血液学毒性，但无严重临床后遗症。
EUS引导下术中组织间近距离放射治疗具有中等程度的局部肿瘤效应，在本研究中30%的患者显示出一定的临床获益。这种治疗形式与外照射和/或化疗联合应用应在未来试验中进行测试。
