Naidu Jeevinesh, Bartholomeusz Dylan, Zobel Joshua, Safaeian Romina, Hsieh William, Crouch Benjamin, Ho Karen, Calnan Deborah, Singhal Nimit, Ruszkiewicz Andrew, Chen John W, Tan Chuan Ping, Dolan Paul, Nguyen Nam Q
Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia.
School of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
Endoscopy. 2022 Jan;54(1):75-80. doi: 10.1055/a-1353-0941. Epub 2021 Jan 14.
This study evaluated clinical outcomes of combined chemotherapy and endoscopic ultrasound (EUS)-guided intratumoral radioactive phosphorus-32 (P) implantation in locally advanced pancreatic adenocarcinoma (LAPC).
Consecutive patients with newly diagnosed LAPC were recruited over 20 months. Baseline computed tomography and F-2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography-computed tomography were performed and repeated after 12 weeks to assess treatment response. Following two cycles of conventional chemotherapy, patients underwent EUS-guided P implantation followed by six chemotherapy cycles.
12 patients with LAPC (median age 69 years [interquartile range 61.5-73.3]; 8 male) completed treatment. Technical success was 100 % with no procedural complications. At 12 weeks, median reduction in tumor volume was 8.2 cm (95 % confidence interval 4.95-10.85; = 0.003), with minimal or no FDG uptake in nine patients (75 %). Tumor downstaging was achieved in six patients (50 %), leading to successful resection in five (42 %), including four R0 resections (80 %).
EUS-guided P implantation was feasible, well tolerated, and resulted in a 42 % surgical resection rate. Further evaluation in a larger randomized multicenter trial is warranted.
本研究评估了联合化疗与内镜超声（EUS）引导下瘤内注射放射性磷-32（P）对局部晚期胰腺癌（LAPC）的临床疗效。
在20个月内连续招募新诊断的LAPC患者。在基线时及12周后分别进行计算机断层扫描（CT）和F-2-氟-2-脱氧-D-葡萄糖（FDG）正电子发射断层扫描-计算机断层扫描（PET-CT）以评估治疗反应。在进行两个周期的传统化疗后，患者接受EUS引导下的P植入，随后再进行六个周期的化疗。
12例LAPC患者（中位年龄69岁[四分位间距61.5 - 73.3]；8例男性）完成治疗。技术成功率为100%，无手术相关并发症。在12周时，肿瘤体积的中位缩小值为8.2 cm（95%置信区间4.95 - 10.85；P = 0.003），9例患者（75%）的FDG摄取极少或无摄取。6例患者（50%）实现了肿瘤降期，其中5例（42%）成功进行了切除，包括4例R0切除（80%）。
EUS引导下的P植入可行，耐受性良好，手术切除率为42%。有必要在更大规模的随机多中心试验中进行进一步评估。
