Response of patients with locally advanced pancreatic adenocarcinoma to high-intensity focused ultrasound treatment: a single-center, prospective, case series in China

Abstract

PurposePatients with unresectable locally advanced pancreatic cancer (LAPC) are still in dire need of effective therapies. We performed this cohort study in order to assess the efficacy and safety of high-intensity focused ultrasound (HIFU) ablation in treating patients with unresectable LAPC.Patients and methodsEighty-seven cases with unresectable LAPC from January 2014 to December 2016 were finally recruited according to the inclusion criteria. The primary end point of our study was OS of all the cases, and the secondary end points included 6-month and 12-month survival rate, tumor response rate, carbohydrate antigen (CA) 19-9 response rate, VAS, quality of life, and safety.ResultsAll the 87 patients received HIFU ablation successfully, and were included in the efficacy and safety analysis. With a median follow-up of 16 months, median OS was estimated to be 12.2 months, with 95 % CI of 11.1–12.7 months. The 6-month and 12-month survival rates were 94.25% (95% CI =86.74–97.57) and 50.85% (95% CI =38.17–62.21), respectively. Multivariate analysis revealed that patients with VAS <4, Karnofsky performance status ≥80, and tumor size <3 cm have a significant improvement in their OS (adjusted HR [aHR] =0.26 [95% CI =0.12–0.57], P=0.001; aHR =0.34 [95% CI =0.17–0.68], P=0.02; and aHR =0.39 [95% CI =0.20–0.78], P=0.007; respectively). Tumor responses were observed in 32 (36.8%) of 87 patients and CA 19-9 response rate was 56.2%. Global health status, physical function, emotional function, and cognitive function of patients were significantly improved after HIFU treatment, and symptoms of fatigue and pain were significantly reduced. A total of 28.7% (25/87) of patients reported adverse events (AEs), mainly including fatigue (14/87), abdominal pain (7/87), fever (7/87), nausea (5/87), and rash (4/87). No severe AEs and HIFU-related deaths were reported.ConclusionHIFU ablation might be a potentially effective and safe therapeutic option for the patients with unresectable LAPC.

Effects of high‑intensity focused ultrasound treatment on peripancreatic arterial and venous blood vessels in pancreatic cancer

“…There were fewer complications and side effects after tumor lesion ablation in the present study compared with previous reports (14,28,33,34,39,40). Meanwhile, no notable clinical symptoms and manifestations of mesenteric vascular occlusion, such as persistent abdominal pain and peritoneal irritation, were observed.…”

“…It was first reported in 2000 that HIFU successfully ablates and treats pancreatic cancer (29). Several studies have confirmed the safety and efficacy of HIFU in the treatment of pancreatic cancer (10,(14)(15)(16)(19)(20)(21)(22)(23)(24)(25)(29)(30)(31)(32)(33)(34). The most common complications observed following HIFU treatment of pancreatic cancer include skin burns (10,15,17,(21)(22)(23)(30)(31)(32), pancreatitis (10,18,23,31,32), duodenal fistula (23,31) and obstructive jaundice (19,34).…”

“…In related studies, patients with pancreatic cancer received RFA and IRE and the primary complications included acute pancreatitis (8,9,(42)(43)(44)(45)(46)48), abdominal pain (46,48), pancreatic fistula (8,9,42,43,45,49), duodenal ulcer or perforation (9,(42)(43)(44)49), gastrointestinal bleeding (42,(44)(45)(46)(47) and biliary fistula (46). In HIFU, the main complications included acute pancreatitis, skin burn, abdominal pain (22,33,34) and elevated amylase expression levels (14,21,33,34), whereas vascular adverse events are rarely recorded and patients can recover and be discharged within a short time (24,25). In addition, HIFU treatment utilizes ultrasound without involving the use of needles, electrodes, probes or similar items, therefore HIFU is safer and less invasive compared with other local ablation methods and can be performed in patients with tumors near vessels, the intestine or the bile duct stent (7).…”

<p>High-intensity focused ultrasound enhances the effect of bufalin by inducing apoptosis in pancreatic cancer cells</p>

“…[21][22][23][24][25] Results from a meta-analysis showed that approximately 80% of patients with advanced PC who received HIFU therapy experienced pain reduction. 26 Ji et al 27 also reported that HIFU treatment was effective and the adverse events (AEs) associated with the treatment were rare and tolerable, especially for old patients and those with poor performance status. 28 Our previous study was also consistent with these results.…”

HIFU for the treatment of gastric cancer with liver metastases with unsuitable indications for hepatectomy and radiofrequency ablation: a prospective and propensity score-matched study Running title: HIFU treatment for gastric cancer with liver metastases

“…Cavitation then ensures and cell death occurs through the process of coagulative necrosis [14,15]. Previous studies have shown that HIFU treatment could treat, including but not limited to liver tumors and pancreatic cancer, and is associated with fewer serious adverse reactions [16,17]. According to our previous studies, HIFU treatment for primary liver cancer and colorectal liver metastases has achieved surprising positive results [18,19].…”