Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China.
Endosc Ultrasound. 2012 Apr;1(1):41-7. doi: 10.7178/eus.01.007.
Both interstitial brachytherapy and interstitial chemotherapy are effective in improving local control in patients with local UICC-T4 pancreatic cancer. In this study, we report the results of endoscopic ultrasound (EUS)-guided interstitial chemoradiation (EUS-ICR) in patients with advanced pancreatic cancer, with respect to tumor response, clinical response, safety, and complications.
A total of 8 patients (3 men, 5 women; median age of 69) with T4 pancreatic adenocarcinoma were the subjects of this study. A mean of 18 radioactive seeds and 36 intratumoral implants for sustained delivery of 5-fluorouracil in each patient were implanted into the tumors using EUS-guided needle puncture. The mean total implanted radioactive activity was 13.68 mCi, the mean total dose of intratumoral 5-fluorouracil was 3.6 g, and the mean volume of implants was 28 cm(3). The conditions of the patients were followed-up by examination and imaging tests every two months. Clinical endpoints included the Karnofsky performance status, pain response, tumor response (assessed by computed tomography and/or EUS), and survival.
During a median follow-up period of 8.3 months, the objective tumor response was classified as "partial" in 1 of 8 patients (with a median duration of partial response of 3 months), "minimal" in 2 patients, and indicative of "stable disease", in 3 of 8 patients. Clinical benefit was shown in 4 of 8 patients, which was mostly due to pain reduction, and lasted for 3.5 months. No local complications or hematologic toxicity occurred.
EUS-ICR had a moderate local anti-tumor effect, showed some clinical benefits in 4 of the 8 patients, and was well tolerated by all the patients in this study.
间质近距离放疗和间质化疗均能有效提高局部控制率，适用于局部 UICC-T4 期胰腺癌患者。本研究旨在报告内镜超声（EUS）引导下间质化疗（EUS-ICR）治疗局部进展期胰腺癌的结果，包括肿瘤反应、临床反应、安全性和并发症。
本研究共纳入 8 例 T4 期胰腺腺癌患者（3 例男性，5 例女性；中位年龄 69 岁）。通过 EUS 引导下的针穿刺，向肿瘤内植入 18 个放射性粒子和 36 个用于持续释放氟尿嘧啶的植入物，每个患者平均植入 18 个放射性粒子和 36 个植入物。平均总植入放射性活度为 13.68mCi，平均肿瘤内氟尿嘧啶总剂量为 3.6g，平均植入物体积为 28cm3。每两个月通过检查和影像学检查对患者病情进行随访。临床终点包括卡氏功能状态评分、疼痛反应、肿瘤反应（通过 CT 和/或 EUS 评估）和生存情况。
中位随访 8.3 个月期间，8 例患者中 1 例（持续缓解时间为 3 个月）肿瘤客观反应为“部分缓解”，2 例为“微小缓解”，3 例为“疾病稳定”。8 例患者中有 4 例临床获益，主要表现为疼痛减轻，持续时间为 3.5 个月。无局部并发症或血液学毒性。
EUS-ICR 具有中度局部抗肿瘤作用，8 例患者中有 4 例显示出一定的临床获益，且所有患者均能耐受。
