Combined chemotherapy and endoscopic ultrasound-guided intratumoral 32P implantation for locally advanced pancreatic adenocarcinoma: a pilot study

Abstract

Aim: This study evaluated clinical outcomes of combined chemotherapy and Endoscopic Ultrasound (EUS) guided intra-tumoral radioactive phosphorus-32 (32P OncoSil) implantation in locally advanced pancreatic adenocarcinoma (LAPC). Methods: Consecutive patients with a new histological diagnosis of LAPC were recruited over 20 months. Baseline CT and 18FDG PET-CT were performed and repeated after 12 weeks to assess response to treatment. Following 2 cycles of conventional chemotherapy, patients underwent EUS-guided 32P OncoSil implantation followed by a further six cycles of chemotherapy. Results: Twelve patients with LAPC (8M:4F; median age 69 years, IQR 61.5-73.3) completed the treatment. Technical success was 100% and no procedural complications were reported. At 12 weeks, there was a median reduction of 8.2cm3 (95% CI 4.95-10.85; p=0.003) in tumour volume, with minimal or no 18FDG uptake in 9 (75%) patients. Tumour downstaging was achieved in 6 (50%) patients, leading to successful resection in 5 (42%) patients, of which 4 patients (80%) had clear (R0) resection margins. Conclusions: EUS guided 32P OncoSil implantation is feasible and well tolerated and was associated with a 42% rate of surgical resection in our cohort. However, further evaluation in a larger randomized multicenter trial is warranted. (32P funded by OncoSil Medical Ltd, equipment and staff funded by the Royal Adelaide Hospital, ClinicalTrials.gov number, NCT03003078).

Advanced Endoscopic Techniques

“…to fistulization with both duodenum and colon. 1 The reported incidence is 0.05-4% of patients undergoing surgery for cholelithiasis.…”

“…size reduction and downstaging of locally advanced pancreatic cancer (LAPC), resulting in successful R0 resection in 42% of patients. 1 Its role in local disease control in patients with metastatic PDAC has not been defined. We sought to evaluate outcomes of combined chemotherapy and intratumoral 32 P implantation for metastatic PDAC.…”

NBTXR3, a first-in-class radioenhancer for pancreatic ductal adenocarcinoma: Report of first patient experience

“…The feasibility of local endoscopic delivery of NBTXR3 may provide a general framework for delivering other local therapeutics including injectable toll-like receptor agonists, STING agonists, and radioactive agents such as 32P-OncoSil to deeper visceral tumors. 13 Our initial experience illustrates the critical importance of multidisciplinary evaluation and management when treating PDAC or other tumors with NBTXR3. With highly integrated care provided by radiation oncologists, gastroenterologists, radiologists, clinical research nurses and staff, and other specialists, we believe that selected patients with PDAC can safely complete EUS-guided intratumoral NBTXR3 injection and radiation therapy.…”

Development of devices for interventional endoscopic ultrasound for the management of pancreatobiliary diseases

“…A brachytherapy treatment with radionuclides of phosphorus-32 using a 22G needle was reported for pancreatic cancer patients. 83,84 CONCLUSION D EVICES SPECIALIZED FOR interventional EUS are being developed for each step of the different procedures, including puncture, guidewire manipulation, tract dilation, and stent placement. In particular, LAMS may open novel opportunities in interventional EUS.…”

“…EUS‐guided brachytherapy in conjunction with chemotherapy may increase the proportion of locally advanced pancreatic cancer patients who are unsuitable for surgery or result in more durable local control than conventional treatments. A brachytherapy treatment with radionuclides of phosphorus‐32 using a 22G needle was reported for pancreatic cancer patients 83,84 …”