Wieners Gero, Schippers Alexander Christian, Collettini Federico, Schnapauff Dirk, Hamm Bernd, Wust Peter, Riess Hanno, Gebauer Bernhard
Department of Diagnostic and Interventional Radiology, Charite-Universitatsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
Hepatobiliary Pancreat Dis Int. 2015 Oct;14(5):530-8. doi: 10.1016/s1499-3872(15)60409-x.
CT-guided high-dose-rate brachytherapy (CT-HDRBT) is an interventional radiologic technique for local ablation of primary and secondary malignomas applying a radiation source through a brachycatheter percutaneously into the targeted lesion. The aim of this study was to assess local tumor control, safety and efficacy of CT-HDRBT in the treatment of liver metastases of pancreatic cancer.
Twenty consecutive patients with 49 unresectable liver metastases of pancreatic cancer were included in this retrospective trial and treated with CT-HDRBT, applied as a single fraction high-dose irradiation (15-20 Gy) using a 192Ir-source. Primary endpoint was local tumor control and secondary endpoints were complications, progression-free survival and overall survival.
The mean tumor diameter was 29 mm (range 10-73). The mean irradiation time was 20 minutes (range 7-42). The mean coverage of the clinical target volume was 98% (range 88%-100%). The mean D100 was 18.1 Gy and the median D100 was 19.78 Gy. Three major complications occurred with post-interventional abscesses, three of which were seen in 15 patients with biliodigestive anastomosis (20%) and overall 15%. The mean follow-up time was 13.7 months (range 1.4-55.0). The median progression-free survival was 4.9 months (range 1.4-42.9, mean 9.4). Local recurrence occurred in 5 (10%) of 49 metastases treated. The median overall survival after CT-HDRBT was 8.6 months (range 1.5-55.3). Eleven patients received chemotherapy after ablation with a median progression-free survival of 4.9 months (mean 12.9). Nine patients did not receive chemotherapy after intervention with a median progression-free survival of 3.2 months (mean 5.0). The rate of local tumor control was 91% in both groups after 12 months.
CT-HDRBT was safe and effective for the treatment of liver metastases of pancreatic cancer.
CT引导下高剂量率近距离放射治疗(CT-HDRBT)是一种介入放射技术,通过将近距离放射导管经皮插入靶病变,对原发性和继发性恶性肿瘤进行局部消融。本研究的目的是评估CT-HDRBT治疗胰腺癌肝转移的局部肿瘤控制情况、安全性和疗效。
本回顾性试验纳入了20例连续的胰腺癌不可切除肝转移患者,共49个转移灶,采用CT-HDRBT治疗,使用192Ir源进行单次大剂量照射(15-20 Gy)。主要终点是局部肿瘤控制,次要终点是并发症、无进展生存期和总生存期。
平均肿瘤直径为29 mm(范围10-73)。平均照射时间为20分钟(范围7-42)。临床靶体积的平均覆盖率为98%(范围88%-100%)。平均D100为18.1 Gy,中位数D100为19.78 Gy。发生了3例主要并发症,为介入后脓肿,其中3例见于15例胆肠吻合患者(20%),总体发生率为15%。平均随访时间为13.7个月(范围1.4-55.0)。无进展生存期的中位数为4.9个月(范围1.4-42.9,平均9.4)。49个接受治疗的转移灶中有5个(10%)发生局部复发。CT-HDRBT后的总生存期中位数为8.6个月(范围1.5-55.3)。11例患者在消融后接受了化疗,无进展生存期中位数为4.9个月(平均12.9)。9例患者在介入后未接受化疗,无进展生存期中位数为3.2个月(平均5.)。12个月后两组的局部肿瘤控制率均为91%。
CT-HDRBT治疗胰腺癌肝转移安全有效。