An endoscopic ultrasonography-guided interstitial brachytherapy based special treatment-planning system for unresectable pancreatic cancer

Abstract

EUS-guided interstitial brachytherapy is promising in the treatment of unresectable malignant carcinoma adjacent to the digestive tract. The feasible treatment plan is not established. Thus, our study aimed to develop a novel treatment plan and evaluate the feasibility in patients with unresectable pancreatic cancer. A total of 42 patients with unresectable pancreatic cancer (stage III: n = 18; stage IV: n = 24) were retrospectively included. A special treatment-planning system (TPS) for EUS was designed and evaluated by comparing with the traditional TPS. The patients underwent EUS-guided interstitial brachytherapy based on the new software. In the test model, there was no obvious difference of irradiation doses calculated by the two softwares (EUS TPS vs. traditional TPS) (P > 0.05). Under the support of EUS TPS, a novel treatment plan for EUS-guided interstitial brachytherapy was successfully established, which contained seven principles. All patients tolerated the treatment well without any serious complications. In 15 patients (stage III) whose minimal peripheral dose was larger than 90 Gy, partial remission rate was 80% (12/15). Twelve patients (12/18) in stage III were alive for over 12 months with a median peripheral dose of 107.5 Gy. The expected median survival time of the 42 patients was 9.0 months (95%CI 7.6-10.4 months). The results demonstrated that the new EUS TPS will play an important role in EUS-guided interstitial brachytherapy in patients with unresectable pancreatic malignant cancer.

Endoscopic Ultrasound in Pancreatic Cancer

“…Sun et al (2017) developed a computer-based treatment planning system that was studied in 42 patients with unresectable PC. In this study, EUS-BT using this software Advances in Pancreatic Cancer was performed and showed an OS for stage III patients of >12 months with an overall median survival time of 9.0 months (95% CI 7.6-10.4 months) [53]. Interestingly, the use of this treatment planning system resulted in no serious adverse events in the study population, which has been a significant criticism of this treatment modality previously.…”

Endoscopic ultrasound guided interventions in the management of pancreatic cancer

“…Another prospective study showed that EUS-guided implantation of iodine-125 around the celiac ganglia can reduce pain visual analog scale score and analgesic drug consumption in patients with unresectable pancreatic cancer. A special EUS treatment planning system software may play a role in EUS-guided brachytherapy in patients with unresectable cancer, as it demonstrated a rate of partial remission of up to 80% in patients whose minimal peripheral dose was larger than 90 Gy, with a median survival time of 9 mo[ 35 ]. In addition to survival benefits, iodine-125 seed implantation placed percutaneously or via EUS after relief of obstructive jaundice via ERCP can improve biliary stent patency, time to development of gastric outlet obstruction, and improve quality of life by pain relief[ 36 ].…”

Endoscopic ultrasound role in pancreatic adenocarcinoma treatment: A review focusing on technical success, safety and efficacy

“…Cancer-related pain improved in 18 patients (81.8%) at 1 wk after the intervention, with an estimated median overall survival of 9 mo and no treatment-related adverse events[ 59 ]. Finally, the most recent study of this modality performed by Sun et al [ 60 ] was in 2017 and included 42 patients; once again the research group demonstrated its safety and efficacy, a median overall survival of 9 mo, and no serious adverse events reported[ 60 ] (Table 3 ).…”