Combined chemotherapy and endoscopic ultrasound-guided intratumoral 32P implantation for locally advanced pancreatic adenocarcinoma: a pilot study
Combined chemotherapy and endoscopic ultrasound-guided intratumoral 32P implantation for locally advanced pancreatic adenocarcinoma: a pilot study
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DOI：
10.1055/a-1353-0941
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发表时间：
2022-01-01
期刊：
影响因子：
9.3
通讯作者：
Nguyen, Nam Q.
中科院分区：
文献类型：
--
作者：
Naidu, Jeevinesh;Bartholomeusz, Dylan;Nguyen, Nam Q.
背景本研究评价了局部晚期胰腺癌（LAPC）联合化疗和内镜超声（EUS）引导下瘤内放射性磷-32（32 P）植入的临床结局。方法收集20个月以上新诊断LAPC的病例。进行基线计算机断层扫描和（18）F-2-氟-2-脱氧-D-葡萄糖（（18）FDG）正电子发射断层扫描-计算机断层扫描，并在12周后重复进行，以评估治疗反应。在两个周期的常规化疗后，患者接受EUS引导的（32）P植入，随后接受六个化疗周期。结果12例LAPC患者（中位年龄69岁[四分位距61.5-73.3]; 8例男性）完成了治疗。技术成功率为100%，无手术并发症。在12周时，肿瘤体积平均减少8.2 cm（3）（95%置信区间4.95-10.85; P = 0.003），9例患者（75%）的FDG摄取量极低或无（18）。6例患者（50%）实现了肿瘤降级，5例（42%）成功切除，包括4例R 0切除（80%）。结论EUS引导下32 P植入是可行的，耐受性良好，手术切除率为42%。需要在更大规模的随机多中心试验中进行进一步评价。
Background This study evaluated clinical outcomes of combined chemotherapy and endoscopic ultrasound (EUS)-guided intratumoral radioactive phosphorus-32 ( (32) P) implantation in locally advanced pancreatic adenocarcinoma (LAPC). Methods Consecutive patients with newly diagnosed LAPC were recruited over 20 months. Baseline computed tomography and (18) F-2-fluoro-2-deoxy-D-glucose ( (18) FDG) 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 (32) P 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 cm (3) (95 % confidence interval 4.95-10.85; P = 0.003), with minimal or no (18) FDG 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 (32) P implantation was feasible, well tolerated, and resulted in a 42 % surgical resection rate. Further evaluation in a larger randomized multicenter trial is warranted.