Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
BJS Open. 2023 May 5;7(3). doi: 10.1093/bjsopen/zrad052.
Pancreatic cancer has one of the worst prognoses of all cancers. Patients with locally advanced pancreatic cancer have a 12.7-20.2 per cent chance of receiving curative surgery after induction systemic chemotherapy. Intratumoral injection therapies have been studied as complementary treatment options for improved local tumour control. The aim of this systematic review was to provide an overview of intratumoral injection therapies, their safety, and oncological outcome in patients with locally advanced pancreatic cancer.
A literature search was conducted in PubMed, Embase and the Cochrane Library for articles written in English up to 28 November 2022. All study designs involving at least five patients with locally advanced pancreatic cancer who were treated with an intratumoral injection therapy were included. Critical appraisal of the included studies was performed using the Newcastle-Ottawa scale.
After evaluation of the 1680 articles yielded by the systematic search, 52 studies treating 1843 patients were included. Included intratumoral injection treatment modalities comprised iodine-125 (125I) seed brachytherapy (32 studies, 1283 patients), phosphorus-32 (32P) microbrachytherapy (5 studies, 133 patients), palladium-103 (103Pd) seed brachytherapy (2 studies, 26 patients), immunotherapy (9 studies, 330 patients), and chemotherapy (4 studies, 71 patients). Overall survival ranged between 7.0 and 16.0 months for 125I, 5.2 and 15.5 months for 32P, 6.9 and 10.0 months for 103Pd, 5.8 and 13.8 months for immunotherapy, and 9.0 and 16.2 months for chemotherapy. Severe complication (greater than or equal to grade III complications using Clavien-Dindo classification) rates were 6.2 per cent for 125I, 49.2 per cent for 32P, 15 per cent for 103Pd, 57.9 per cent for immunotherapy, and 0 per cent for chemotherapy.
Five intratumoral injection therapies are described and an overview is reported. Some intratumoral injection therapies for patients with locally advanced pancreatic cancer seem safe, although 32P microbrachytherapy and immunotherapy require additional evidence. Currently available data are insufficient to provide firm conclusions regarding the added value to survival. The potential advantage of intratumoral injection therapies complementary to conventional care should be studied in well designed RCTs.
胰腺癌的预后是所有癌症中最差的之一。接受诱导全身化疗后，局部进展期胰腺癌患者有 12.7-20.2%的机会接受治愈性手术。瘤内注射疗法已被研究为改善局部肿瘤控制的补充治疗选择。本系统评价的目的是提供局部进展期胰腺癌瘤内注射治疗及其安全性和肿瘤学结局的概述。
在 PubMed、Embase 和 Cochrane 图书馆中对截至 2022 年 11 月 28 日发表的英文文章进行了文献检索。纳入了至少有 5 例局部进展期胰腺癌患者接受瘤内注射治疗的所有研究设计。使用纽卡斯尔-渥太华量表对纳入的研究进行了批判性评估。
通过系统搜索评估了 1680 篇文章后，纳入了 52 项研究，共纳入了 1843 例患者。纳入的瘤内注射治疗方式包括碘-125（125I）种子近距离放疗（32 项研究，1283 例患者）、磷-32（32P）微近距离放疗（5 项研究，133 例患者）、钯-103（103Pd）种子近距离放疗（2 项研究，26 例患者）、免疫治疗（9 项研究，330 例患者）和化疗（4 项研究，71 例患者）。125I 的总生存率为 7.0 至 16.0 个月，32P 为 5.2 至 15.5 个月，103Pd 为 6.9 至 10.0 个月，免疫治疗为 5.8 至 13.8 个月，化疗为 9.0 至 16.2 个月。125I 的严重并发症（Clavien-Dindo 分级≥3 级并发症）发生率为 6.2%，32P 为 49.2%，103Pd 为 15%，免疫治疗为 57.9%，化疗为 0%。
描述了 5 种瘤内注射治疗方法，并报告了概述。对于局部进展期胰腺癌患者，一些瘤内注射治疗似乎是安全的，尽管 32P 微近距离放疗和免疫治疗需要更多的证据。目前的可用数据不足以对生存的附加价值得出明确的结论。应在精心设计的 RCT 中研究瘤内注射治疗作为常规治疗的补充的潜在优势。
