联合化疗与内镜超声引导下瘤内 32P 植入治疗局部晚期胰腺腺癌：一项前瞻性研究。

Combined chemotherapy and endoscopic ultrasound-guided intratumoral 32P implantation for locally advanced pancreatic adenocarcinoma: a pilot study.

作者信息

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

机构信息

Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia.

School of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.

出版信息

Endoscopy. 2022 Jan;54(1):75-80. doi: 10.1055/a-1353-0941. Epub 2021 Jan 14.

DOI:10.1055/a-1353-0941

PMID:33440437

Abstract

BACKGROUND

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).

METHODS

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.

RESULTS

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 %).

CONCLUSIONS

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.

摘要

背景

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。

方法

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。

结果

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%）。