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ORIGINAL ARTICLE
Year : 2012  |  Volume : 1  |  Issue : 1  |  Page : 41-47

Pilot trial of endoscopic ultrasound-guided interstitial chemoradiation of UICC-T4 pancreatic cancer


Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China

Correspondence Address:
Siyu Sun
Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.7178/eus.01.007

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Background and aims: Both interstitial brachytherapy and interstitial chemotherapy are effective in improving local control in patients with local UICC-T4 pancreatic cancer. In this study, we report the results of endoscopic ultrasound (EUS)-guided interstitial chemoradiation (EUS-ICR) in patients with advanced pancreatic cancer, with respect to tumor response, clinical response, safety, and complications. Patients and methods: A total of 8 patients (3 men, 5 women; median age of 69) with T4 pancreatic adenocarcinoma were the subjects of this study. A mean of 18 radioactive seeds and 36 intratumoral implants for sustained delivery of 5-fluorouracil in each patient were implanted into the tumors using EUS-guided needle puncture. The mean total implanted radioactive activity was 13.68 mCi, the mean total dose of intratumoral 5-fluorouracil was 3.6 g, and the mean volume of implants was 28 cm3. The conditions of the patients were followed-up by examination and imaging tests every two months. Clinical endpoints included the Karnofsky performance status, pain response, tumor response (assessed by computed tomography and/or EUS), and survival. Results: During a median follow-up period of 8.3 months, the objective tumor response was classified as 'partial' in 1 of 8 patients (with a median duration of partial response of 3 months), 'minimal' in 2 patients, and indicative of 'stable disease, in 3 of 8 patients. Clinical benefit was shown in 4 of 8 patients, which was mostly due to pain reduction, and lasted for 3.5 months. No local complications or hematologic toxicity occurred. Conclusions: EUS-ICR had a moderate local anti-tumor effect, showed some clinical benefits in 4 of the 8 patients, and was well tolerated by all the patients in this study.


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