Title: Clinical Efficacy of CT-guided Iodine-125 Seed Implantation Therapy in Patients with Advanced Pancreatic Cancer
Abstract: Objective The purpose of this study was to examine the clinical efficacy of CT-guided radioactive iodine-125 (I-125) seeds implantation treatment in patients with unresectable pancreatic cancer. Materials and Methods 31 patients with unresectable pancreatic cancer were enrolled in this study. Treatment Planning System (TPS) was used to reconstruct 3 Dimensional image of pancreatic tumor and to define the quantity and distribution of I-125 seeds. Iodine 125 seeds with the activities ranged from 0.5 to 0.8 mCi/seed were implanted into pancreatic tumor under CT guidance. During the procedure, vessels, pancreatic tube and other nearby organs should be avoided hurted with 1 to 1.5 cm space of each seed..In addition, 10 patients received concurrent chemotherapy with arterial infusion of gemcitabin and 5-fluororacil (5-Fu), 3 to 4 cycles in total. Results of the 31 patients involved in this study, 18 were male, 13 were female, and age ranged from 40 to 89 with 65.5 on average. Median diameter of the tumors was 5.8 cm. Follow-up period was 2 to 25 months. Symptoms of refractory pain were significantly resolved post interventionally (P0.05), and Karnofsky score increased dramatically (P0.05). The pain relieved at average 2 to 5 days after implantation. Tumor response which was demonstrated on follow up CT images 2 months after treatment revealed completed relief (CR) in 3 cases, partial relief (PR) in 16 cases, no change (NC) in 9 cases and progression (PD) in 3 cases. Overall responding rate (CR+PR) for patients turned out to be 61.3%. Median survival time for all patients was 10.31 months, while for stage Ⅱ, stage ⅡI, and stage IV were 14 months,11 months and 6 months respectively. The 6-month and 12-month cumulative survival rates of stage subgroups were 89%, 70%, 58% and 44%, 30%, 0% .After implantation, 10 patients received 3 to 4 cycles concurrent chemotherapy with arterial infusion of gemcitabin and 5-fluororacil (5-Fu). Among them, 3 cases with liver metastasis were combined with embolic chemotherapy perfusion.2 seeds of radioactive I-125 found to migrate to liver in 2 patients. There were no serious complications such as upper GI bleeding, pancreatitis, pancreatic fistula formation and radiation colitis detected during follow up. Conclusion This study suggested that CT guided brachytherapy using I-125 seeds implantation is a safe, effective and less complicated method. I-125 seeds implantation can produce adequate pain relief for treating unresectable pancreatic cancer. However, this result requires further validation to determine its long term efficacy.
Publication Year: 2008
Publication Date: 2008-01-01
Language: en
Type: article
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