Endoscopy 2022; 54(01): 75-80
DOI: 10.1055/a-1353-0941
Innovations and brief communications

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

1  Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
2  School of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
,
Dylan Bartholomeusz
1  Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
2  School of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
3  Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, Australia
,
Joshua Zobel
1  Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
,
Romina Safaeian
1  Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
,
William Hsieh
3  Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, Australia
,
Benjamin Crouch
3  Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, Australia
,
Karen Ho
3  Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, Australia
,
Deborah Calnan
3  Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, Australia
,
Nimit Singhal
4  Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, Australia
,
Andrew Ruszkiewicz
2  School of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
5  Department of Pathology, Royal Adelaide Hospital, Adelaide, Australia
,
John W. Chen
6  Department of Hepatobiliary Surgery, Royal Adelaide Hospital, Adelaide, Australia
,
Chuan Ping Tan
6  Department of Hepatobiliary Surgery, Royal Adelaide Hospital, Adelaide, Australia
,
Paul Dolan
6  Department of Hepatobiliary Surgery, Royal Adelaide Hospital, Adelaide, Australia
,
Nam Q. Nguyen
1  Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
2  School of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
› Author Affiliations
Trial Registration: ClinicalTrials.gov Registration number (trial ID): NCT03003078 Type of study: Prospective, Single Centre

Abstract

Background This study evaluated clinical outcomes of combined chemotherapy and endoscopic ultrasound (EUS)-guided intratumoral radioactive phosphorus-32 (32P) implantation in locally advanced pancreatic adenocarcinoma (LAPC).

Methods Consecutive patients with newly diagnosed LAPC were recruited over 20 months. Baseline computed tomography and 18F-2-fluoro-2-deoxy-D-glucose (18FDG) 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 32P 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 cm3 (95 % confidence interval 4.95–10.85; P = 0.003), with minimal or no 18FDG 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 32P implantation was feasible, well tolerated, and resulted in a 42 % surgical resection rate. Further evaluation in a larger randomized multicenter trial is warranted.

Fig. 1s, 2s, Table 1s, 2s



Publication History

Received: 29 January 2020

Accepted after revision: 13 January 2021

Publication Date:
13 January 2021 (online)

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