EUS-guided verteporfin photodynamic therapy for pancreatic cancer.
EUS-guided verteporfin photodynamic therapy for pancreatic cancer.
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DOI：
10.1016/j.gie.2021.02.027
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发表时间：
2021-07
影响因子：
7.7
通讯作者：
Wang, Kenneth K.
中科院分区：
文献类型：
--
作者：
Hanada, Yuri;Pereira, Stephen P.;Pogue, Brian;Maytin, Edward, V;Hasan, Tayyaba;Linn, Bryan;Mangels-Dick, Tiffany;Wang, Kenneth K.
局部晚期胰腺癌（LAPC）通常会导致梗阻。维替泊芬光动力疗法（PDT）可以比非治愈性手术更安全地“缩小”肿瘤，并且比旧的PDT药物具有多种优势。我们的目的是评估EUS引导的维替泊芬PDT消融不可切除LAPC的可行性。前瞻性入组具有充分胆道引流的LAPC成人患者。排除标准包括显著的转移性疾病负担、累及>50%十二指肠或主要动脉周长的疾病以及近期有治愈意图的治疗。在第-28天至第0天之间获得CT。在第0天，在EUS之前60至90分钟输注0.4mg/kg的维替泊芬，在此期间，将扩散器定位在肿瘤中并以50 J/cm递送光333秒。在第2天获得CT，在第1、2和14天进行不良事件监测。主要结局是出现坏死。在研究中纳入的8例患者（62.5%为男性，平均年龄65±7.9岁）中，5例在T3分期，2例在T2分期，1例在T1分期。大多数（4例）原发性病变位于胰头。试验前平均肿瘤直径为33.3±13.4 mm。在第2天CT上，5个病灶显示出平均直径为15.7±5.5 mm的坏死区; 3例未发生坏死。在手术或术后观察期（第1-3天）未观察到不良事件，也未观察到患者报告结局的变化。在这项初步研究中，EUS引导的维替泊芬PDT是可行的，并显示出作为LAPC的微创消融治疗在选定的患者的前景。治疗后48小时内可见肿瘤坏死。患者入组和数据收集正在进行中。
Locally advanced pancreatic cancer (LAPC) often causes obstruction. Verteporfin photodynamic therapy (PDT) can feasibly “debulk” tumor more safely than noncurative surgery and has multiple advantages over older PDT agents. We aimed to assess the feasibility of EUS-guided verteporfin PDT in ablating nonresectable LAPC. Adults with LAPC with adequate biliary drainage were prospectively enrolled. Exclusion criteria included significant metastatic disease burden, disease involving >50% duodenal or major artery circumference, and recent treatment with curative intent. CT was obtained between day −28 to 0. On day 0, verteporfin 0.4 mg/kg was infused 60 to 90 minutes before EUS, during which a diffuser was positioned in the tumor and delivered light at 50 J/cm for 333 seconds. CT was obtained on day 2, with adverse event monitoring occurring on days 1, 2, and 14. Primary outcome was presence of necrosis. Of 8 patients (62.5% male, mean age 65±7.9 y) included in the study, 5 were staged at T3, 2 at T2, and 1 at T1. Most (4) had primary lesions in the pancreatic head. Mean pretrial tumor diameter was 33.3±13.4 mm. On day 2 CT, 5 lesions demonstrated a zone of necrosis measuring a mean diameter of 15.7±5.5 mm; 3 cases did not develop necrosis. No adverse events were noted during the procedure or postprocedure observation period (day 1–3), and no changes in patient reported outcomes were noted. In this pilot study, EUS-guided verteporfin PDT is feasible and shows promise as a minimally invasive ablative therapy for LAPC in select patients. Tumor necrosis is visible within 48 hours after treatment. Patient enrollment and data collection are ongoing.
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