PDF(Pubmed)
Abstract：
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 (125I) 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 125I 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 125I 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 125I 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 125I 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 125I interstitial brachytherapy, which may provide new ideas and methods for the treatment of pancreatic cancer.
摘要：
诊断为胰腺癌且5年生存率约为5%的患者通常处于晚期。在美国，胰腺癌已成为癌症相关死亡的第三大原因，仍然缺乏有效的治疗方法来提高患者的生存率。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125碘(125I)间质近距离放射治疗对不符合或拒绝手术和化疗的晚期胰腺癌患者的潜在临床影响.共有52例诊断为晚期胰腺癌的患者被纳入研究。每位患者至少接受一个疗程的HIFU治疗结合经皮超声引导下125I粒子植入。临床评估包括基线时Karnofsky性能量表（KPS）评分的评估，联合治疗后1个月和2个月。另外用数值评分(NRS)评价疼痛强度。评价联合治疗后3、6、9、12个月的总生存期(OS)时间和生存率。记录通常与HIFU和125I粒子植入相关的不良事件。根据不良事件通用术语标准对不良事件的严重程度进行分级，版本4。所有52例患者均成功重复HIFU治疗联合125I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个月的生存率分别为100.0、86.5、61.5和53.8％，分别。基线时平均KPS评分为62.7±6.3,联合治疗后1个月为73.7±7.9，2个月为68.8±6.5。联合治疗后KPS评分显著升高。基线时平均NRS评分为6.7±1.6,联合治疗后1个月和2个月分别为4.7±1.7和5.4±1.5，分别。与基线相比，125I粒子植入后1个月和2个月的严重疼痛患者人数和NRS评分均显着降低。随访期间未发现严重并发症。总之,本研究证明了接受反复HIFU治疗联合125I近距离放射治疗的晚期胰腺癌患者的生存获益和生活质量的改善。为胰腺癌的治疗提供新的思路和方法。
