Background and Study Aims: Intraoperative interstitial brachytherapy has been found to be effective when used
during laparotomy to improve local control in patients with locally advanced pancreatic
cancer. In this study, we report the results of using endoscopic ultrasound- (EUS-)guided
interstitial brachytherapy in patients with advanced pancreatic cancer, with respect
to tumor response, clinical response, safety, and complications.
Patients and Methods: Fifteen patients (eight men, seven women; median age 61 years) with unresectable
pancreatic adenocarcinoma were enrolled into the study, eight patients with stage
III disease and seven patients with stage IV disease. A mean number of 22 radioactive
seeds per patient were implanted into the tumors by EUS-guided needle puncture. The
mean total implanted activity was 20 mCi, the minimum peripheral dose was 14 000 cGy,
and the mean volume of implants was 52 cm3. Patients were followed-up by examination and by imaging tests every 2 - 3 months:
clinical end points included the Karnofsky performance status and pain responses,
tumor response (assessed by computed tomography and/or EUS), and survival.
Results: During a median follow-up period of 10.6 months, the objective tumor response was
classified as “partial” in 27 % of patients (with a median duration of partial response
of 4.5 months), ”minimal” in 20 % patients, and indicative of “stable disease” in
33 % of patients. Clinical benefit was shown in 30 % of patients, mostly due to reduction
in pain, but this lasted for a limited time. Local complications (pancreatitis and
pseudocyst formation) occurred in three patients; grade III hematologic toxicity occurred
in three patients without serious clinical sequelae.
Conclusions: EUS-guided intraoperative interstitial brachytherapy had a moderate local tumor effect
and showed some clinical benefit in 30 % of the patients in this study. Combination
of this form of treatment with external radiation and/or chemotherapy should be tested
in future trials.
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S. Sun, M. D.
Endoscopy Center
The Second Hospital of China Medical University · Sanhao Street 36 · Shenyang · Liaoning
· Province, 110004 · China
Fax: +86-24-23892617
eMail: sunsy@cmu2h.com
