Liu Yumei, Ji Yongshuo, Zhu Junqiu, Zhu Linglin, Zhu Yanfei, Bao Zhijun, Zhao Hong
High-Intensity Focused Ultrasound Center of Oncology Department, Huadong Hospital Affiliated to Fudan University, Shanghai 200000, P.R. China.
Department of Gerontology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China.
Oncol Lett. 2024 Feb 16;27(4):157. doi: 10.3892/ol.2024.14290. eCollection 2024 Apr.
Patients diagnosed with pancreatic cancer who have 5-year survival rates of ~5% are typically in the advanced stage. Pancreatic cancer has become the third leading cause of cancer-related death in the United States and there is still a lack of effective treatments to improve patient survival rate. Hence, the purpose of the present retrospective study was to assess the potential clinical impact of repeated high-intensity focused ultrasound (HIFU) combined with iodine-125 (I) interstitial brachytherapy for the treatment of patients with advanced pancreatic cancer who were ineligible for or declined surgery and chemotherapy. A total of 52 patients diagnosed with advanced pancreatic cancer were included in the study. At least one course of HIFU therapy combined with percutaneous ultrasound-guided I seed implantation was administered to each patient. The clinical assessment included an evaluation of Karnofsky Performance Scale (KPS) score at baseline, and at 1 and 2 months after combined therapy. Pain intensity was additionally evaluated with the numerical rating score (NRS). Overall survival (OS) times and survival rates at 3, 6, 9 and 12 months after combined treatment were evaluated. Adverse events commonly associated with HIFU and I seed implantation were recorded, and the severity of adverse events was graded according to the Common Terminology Criteria for Adverse Events, version 4. All 52 patients received successful repeated HIFU treatment combined with I seed implantation and were included in the analysis of efficacy and safety. The median OS time of patients was estimated to be 13.1 months (95% CI, 11.3-14.8). The survival rates at 3, 6, 9 and 12 months were 100.0, 86.5, 61.5 and 53.8%, respectively. The mean KPS score was 62.7±6.3 at baseline, 73.7±7.9 at 1 month and 68.8±6.5 at 2 months after combined treatment. KPS score increased significantly after combined therapy. The mean NRS score was 6.7±1.6 at baseline, and 4.7±1.7 and 5.4±1.5 at 1 and 2 months after combined treatment, respectively. The number of patients with severe pain and the NRS score were both significantly lower at 1 and 2 months after I seed implantation compared with those at baseline. No serious complications were detected during the follow-up period. In conclusion, the present study demonstrated the survival benefit and improvement in quality of life of patients with advanced pancreatic cancer receiving repeated HIFU treatment combined with I interstitial brachytherapy, which may provide new ideas and methods for the treatment of pancreatic cancer.
被诊断为胰腺癌且5年生存率约为5%的患者通常处于晚期。胰腺癌已成为美国癌症相关死亡的第三大主要原因，目前仍缺乏有效的治疗方法来提高患者生存率。因此，本回顾性研究的目的是评估重复高强度聚焦超声（HIFU）联合碘-125（I）组织间近距离放疗对不符合手术或拒绝手术及化疗的晚期胰腺癌患者的潜在临床影响。本研究共纳入52例被诊断为晚期胰腺癌的患者。对每位患者至少进行一个疗程的HIFU治疗联合经皮超声引导下I粒子植入。临床评估包括基线时、联合治疗后1个月和2个月时的卡氏功能状态评分（KPS）评估。另外用数字评分量表（NRS）评估疼痛强度。评估联合治疗后3、6、9和12个月的总生存期（OS）及生存率。记录与HIFU和I粒子植入常见相关的不良事件，并根据《不良事件通用术语标准》第4版对不良事件的严重程度进行分级。所有52例患者均成功接受了重复HIFU治疗联合I粒子植入，并纳入疗效和安全性分析。患者的中位OS时间估计为13.1个月（95%CI，11.3 - 14.8）。3、6、9和12个月时的生存率分别为100.0%、86.5%、61.5%和53.8%。联合治疗后，基线时KPS平均评分为62.7±6.3，1个月时为73.7±7.9，2个月时为68.8±6.5。联合治疗后KPS评分显著提高。基线时NRS平均评分为6.7±1.6，联合治疗后1个月和2个月时分别为4.7±1.7和5.4±1.5。与基线相比，I粒子植入后1个月和2个月时重度疼痛患者数量及NRS评分均显著降低。随访期间未发现严重并发症。总之，本研究表明，接受重复HIFU治疗联合I组织间近距离放疗的晚期胰腺癌患者有生存获益且生活质量得到改善，这可能为胰腺癌治疗提供新的思路和方法。
