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

Abstract

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.

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“…Standard aspiration needles (19 gauge (G), 22G, 25G) as well as a special 20G injection needle may be used [20]. Preliminary reports have described the effective use of phenol instead of alcohol in patients intolerant to alcohol [21] and the insertion of radioactive seeds [22,23].…”

“…EUS-guided I 125 implantation was technically feasible in 15 patients with unresectable pancreatic cancer, 8 with stage III disease and 7 with stage IV disease [368]. The clinical efficacy and safety of EUS-guided implantation of radioactive I 125 seeds in advanced pancreatic cancer was evaluated with routine gemcitabine-based 5-FU chemotherapy 1 week after brachytherapy [23]. Compared with brachytherapy alone [369], the combination of chemotherapy and radioactive I 125 seeds did not demonstrate better tumor response nor long-term effects.…”

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

“…EUS-guided intraoperative interstitial brachytherapy had a moderate local tumor effect and showed some clinical benefit in one third of 15 patients, with some severe hematological complications, pancreatitis, and pseudocyst formation, but without serious clinical sequelae [131]. Another study involving EUS-guided implantation of seeds in local advanced adenocarcinoma showed improvement in pain control, but no survival benefit [132].…”

Endoscopic ultrasound: what is it and when should it be used?

“…guidance and can detect and drain ascites not apparent on CT. 25,26 Experimental applications of EUS undergoing current study include local delivery of brachytherapy or chemotherapy in advanced pancreatic cancer, 27 alcohol ablation of adrenal metastases 28 or pancreatic neuroendocrine tumours 29 and EUS-guided submucosal implantation of radiopaque markers prior to radiotherapy. 30 The rapid development of natural orifice transluminal endoscopic surgery is now blurring the boundaries between endoscopy and surgery with EUS playing a key role in its future.…”