Magnetic Resonance-Guided High-Intensity Focused Ultrasound Treatment of Locally Advanced Pancreatic Adenocarcinoma Preliminary Experience for Pain Palliation and Local Tumor Control
Magnetic Resonance-Guided High-Intensity Focused Ultrasound Treatment of Locally Advanced Pancreatic Adenocarcinoma Preliminary Experience for Pain Palliation and Local Tumor Control
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DOI：
10.1097/rli.0000000000000080
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发表时间：
2014-12-01
影响因子：
6.7
通讯作者：
Napoli, Alessandro
中科院分区：
文献类型：
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作者：
Anzidei, Michele;Marincola, Beatrice Cavallo;Napoli, Alessandro
目的：本研究的目的是评估磁共振引导聚焦超声（MRgFUS）消融对不可切除的原发性胰腺腺癌患者疼痛缓解和局部肿瘤控制的可行性。材料和方法：在提供专门的知情同意书后，7例组织学证实不可切除的胰腺腺癌患者在专用的3-T设备上接受了MRgFUS治疗，该设备具有专用的消融系统。治疗前对所有病变进行器械可及性评估。MRgFUS在全身麻醉下进行，持续控制呼吸。临床评估包括治疗前后使用视觉模拟量表评估症状严重程度。影像学随访，包括计算机断层扫描和磁共振检查，在治疗后立即和3个月和6个月进行，以评估MRgFUS对目标肿瘤的影响以及手术相关并发症的发生（如果有的话）。结果：6例患者成功行MRgFUS消融；在手术过程中或手术后未观察到不良事件。在单个患者中，病变在治疗时受到限制，手术暂停。治疗后，所有患者的视觉模拟量表评分从平均（SD） 7(1)降至3(1)。随访影像结果显示消融区肿瘤可忽略（n = 1）或未再生（n = 5）。1名患者在治疗后13个月死于转移性疾病，而其他5名患者在治疗后6个月和8个月未进展。结论：我们的初步临床经验表明，MRgFUS是一种可行的、可重复的消融技术，适用于不可切除和设备可及的胰腺腺癌患者。
Purpose: The purpose of this study was to evaluate the feasibility of magnetic resonance-guided focused ultrasound (MRgFUS) ablation for pain palliation and local tumor control in selected patients with unresectable primary pancreatic adenocarcinoma.Materials and Methods: After providing dedicated informed consent, 7 patients with histologically proven unresectable pancreatic adenocarcinoma underwent MRgFUS treatment on a dedicated 3-T unit featuring a dedicated ablation system. All lesions were evaluated for device accessibility before the treatment. Procedures of MRgFUS were performed with the patients under general anesthesia with constant controlled respiration. Clinical assessment included evaluation of symptom severity using a visual analog scale before and after the treatment. Imaging follow-up, including both computed tomographic and magnetic resonance examinations, was performed immediately after the treatment and at 3 and 6 months to evaluate the effects of MRgFUS on the targeted tumor and the occurrence, if any, of procedure-related complications.Results: The MRgFUS ablation was successfully performed in 6 patients; no adverse events were observed during or after the procedure. In a single patient, lesion accessibility was limited at treatment time, and the procedure was suspended. The visual analog scale score decreased in all patients from a mean (SD) of 7 (1) to 3 (1) after the treatment. Follow-up imaging results revealed negligible (n = 1) or no (n = 5) tumor regrowth within the ablation area. One patient died because of a metastatic disease 13 months after the treatment, whereas the other 5 are nonprogressing survivors at 6 and 8 months after the treatment.Conclusions: Our preliminary clinical experience suggests that MRgFUS is a feasible and repeatable ablative technique in selected patients with unresectable and device-accessible pancreatic adenocarcinoma.