Endoscopic ultrasonography-guided interstitial implantation of iodine 125-seeds combined with chemotherapy in the treatment of unresectable pancreatic carcinoma: a prospective pilot study

BACKGROUND AND STUDY AIMS

Intraoperative and transdermal ultrasonography-mediated brachytherapy has been proved to be effective in postponing the development of abdominal carcinomas. The main purpose of this study was to evaluate the clinical efficacy and safety of endoscopic ultrasonography (EUS)-guided interstitial implantation of radioactive iodine 125 seeds in advanced pancreatic cancer.

PATIENTS AND METHODS

In total, 22 patients with advanced pancreatic cancer and positive fine-needle aspiration results underwent EUS-guided interstitial implantation of iodine seeds. All enrolled patients received routine gemcitabine-based 5-fluorouracil chemotherapy 1 week after brachytherapy.

RESULTS

All 22 patients were successfully implanted with 125I seeds via EUS, with a median of 10 seeds and a maximum of 30 seeds per procedure. The median follow-up time of patients was 9.3 months, and the estimated median survival time was 9.0 months (95 % confidence interval 6.7 - 11.3 months). Partial remission was achieved in three cases (13.6 %) during the 4-week period, and disease in 10 patients (45.5 %) remained stable. Cancer finally progressed in 20 patients, all of whom died during 2 years of follow-up. Visual analog scale pain score dropped from 5.07 +/- 2.63 to 1.73 +/- 1.91 ( P< 0.01) 1 week after brachytherapy but increased again to 3.53 +/- 1.51 1 month later ( P< 0.05 vs. baseline). There were no obvious complications following therapy.

CONCLUSIONS

EUS-guided interstitial implantation of 125I seeds may represent a safe alternative treatment option for locally advanced pancreatic cancer. Our preliminary data suggest improvement in pain, but no long-term survival benefit.

Endoscopic ultrasound-guided fiducial markers and brachytherapy

Endoscopic ultrasound (EUS)-guided needle placement of small radiopaque particles paves the way for EUS-guided fiducial markers and brachytherapy. Stereotactic body radiation therapy relies on image-guided radiation therapy (IGRT), permitting escalation of radiation dose to tumors while minimizing dose to normal tissues. Fiducial markers are radiopaque spheres, coils, or seeds that are implanted in or near tumors for IGRT. Brachytherapy is a therapeutic modality for various cancers. Both require precise and minimally-invasive seed placement, which EUS provides. This article reviews recent literature regarding the safety and efficacy of these procedures and discusses novel concepts, including EUS-guided celiac ganglia radiation neurolysis.

[Application of endoscopic ultrasonography in the diagnosis and management of gastrointestinal cancers]

Since its initial introduction in clinical practice, endoscopic ultrasonography(EUS) has been considered as a valuable tool for the diagnosis and staging of gastrointestinal cancers. With the improvement of equipments in the past decade, EUS-guided fine needle aspiration (EUS-FNA) techniques has been greatly developed, which opens a new avenue to therapeutic EUS. At present, endoscopic ultrasonography (EUS) has been widely applied in the clinical practice of the diagnosis and management of gastrointestinal cancers. In this paper, we summarize the latest data of the applications of EUS in the diagnosis and management of gastrointestinal cancers.

[The clinical value of endoscopic ultrasonography in early diagnosis of pancreatic tumor]

OBJECTIVE

To investigate the clinical value of endoscopic ultrasonography (EUS) and intraductal ultrasonography (IDUS) compared with the other imaging examination in the early diagnosis of pancreatic tumor.

METHODS

Retrospect studied of 188 cases of small pancreatic lesions (less than 3 cm in diameter) detected by EUS, IDUS and the other imaging examination at Changhai hospital from October 1992 to September 2006.

RESULTS

(1) The accurate rate of small pancreatic cancer diagnosed by EUS was 95.6%, and it is better compared with US (58.6%), CT (77.4%), MRI (76.2%) and ERCP (85.3%). The most common endosonographic features of small pancreatic cancer were alike round, irregular edge, hypoechoic mass with uniformity internal echo. (2) IDUS was performed in 25 cases of small pancreatic lesions, the accurate rate of diagnosis was 100% (25/25), and it is better compared with US 32.0% (8/25), CT 52.9% (9/17) and MRI 57.9% (11/19). (3) EUS guided FNA (EUS-FNA) was performed in 18 cases of small pancreatic lesions, the accurate rate of diagnosis was 66.7% (12/18). (4) The accurate rate of pseudocyst diagnosis by EUS was 100.0% (27/27), it is better compared with US 52.0% (13/25), CT 66.7% (12/18), MRI 82.4% (14/17) and ERCP 78.9% (15/19); and the overall accurate rate of diagnosis of cystic pancreatic tumors by EUS was 57.7% (15/26), it is better compared with US 19.2% (5/26), CT 36.4% (8/22), MRI 37.5% (6/16) and ERCP 50.0% (7/14).

CONCLUSIONS

EUS and IDUS were better than the other imaging examinations in the detection of small pancreatic tumors.