| AIMS: Pancreatic cancer has been accepted as one of the most difficult-to-treat cancers.Implantation iodine125(125I)seeds by endoscopic ultrasonography (EUS) is a noveltreatment, but the Long-term effect remains controversial. To investigate the long-termefficacy of iodine-125(I-125) seeds implantation by EUS-guidance and postoperativechemotherapy in the treatment of un-resectable pancreatic cancer.Material and methods: From2005May to2011Dec, totally100cases of pancreatic cancerunderwent EUS-guided interstitial implantation of iodine seeds. Mean age was60.95years(33-82years).The staging of T1-T2in25%, T3in35%and T4in40%.In total, all patientswith pancreatic cancer and positive fine needle aspiration results (except surge confirmed)underwent EUS-guided interstitial implantation of iodine seeds. All enrolled patients receivedroutine gemcitabine based chemotherapy1week after brachytherapy. The chemotherapy wasrepeated every4weeks for up to six cycles if tolerated. Groups: Firstly, patients were dividedinto groups by TNM stage:⑴stageⅠ/Ⅱof the pancreatic cancer;⑵stageⅢ/Ⅳof thepancreatic cancer. Secondly, patients were divided into groups by prior-chemotherapy ornon-prior chemotherapy before implantation of iodine125seeds:⑴prior-chemotherapysubgroup;⑵non-prior chemotherapy subgroup. Thirdly, patients were divided into groups bypost-chemotherapy or non-post chemotherapy after implantation of iodine125seeds:⑴postchemotherapy subgroup;⑵non-post chemotherapy subgroup.Results: All of the100patients were successfully implanted with125I seeds via EUS. Therewere63treated with only one implantation, with a median number of14.7seeds (range5–30).26patients underwent implantation twice with a median number of35.2seeds (range10–55),10patients underwent the procedure three times with a median number of53.2seeds (range30–81).1patients underwent implantation forth with37seeds.The mean follow-up time ofpatients was7.805±6.104months (range0.3–36months until patients died), and the expectedmedian progression-free survival time and survival time of all100patients was4.50months(95%confidence interval,3.131–5.869months)and7.00months (95%confidence interval,5.253–8.747months), respectively. The estimated1-year survival rate was21.0%.Theestimated2-year survival rate was4.0%.Comparison VAS scores between non-prior chemotherapy and prior chemotherapy at baseline and at1week,1month and3months after brachytherapy were1.173E3(Mann-whitney U test, P>0.05),940.500(Mann-whitney U test, P<0.05),1104.000(Mann-whitney U test, P>0.05),738.500(Mann-whitney U test, P>0.05), respectively.Comparison survival time between non-prior chemotherapy and prior chemotherapy showedP>0.05[Log Rank(Mantel-cox)]、 P>0.05[Breslow (Generalized Wilcoxon)]andP>0.05(Tarone-Ware),respectively.Comparison VAS scores between non-post chemotherapy and post chemotherapy atbaseline and at1week,1month and3months after brachytherapy were587(Mann-whitneyU test,P>0.05),610(Mann-whitney U test,P<0.05),527(Mann-whitney U test,P>0.05),296(Mann-whitney U test,P>0.05), respectively. Comparison survival time between non-postchemotherapy and post chemotherapy showed P<0.05[Log Rank(Mantel-cox)]、P<0.05[Breslow (Generalized Wilcoxon)]and P<0.05(Tarone-Ware),respectively. Therefore,there were obviously significant differences between the post-chemotherapeutic subgroup andthe non-post chemotherapeutic subgroup of the expected survival time.Conclusions: The outcome of patients with pancreatic carcinoma treated with I-125seed byEUS-guided interstitial is very good with improvement in pain with very low complicationsrate. But our data show there is no obviously long-term survival and progression-free survival(PFS) benefit. At the same time the patients of prior chemotherapy before seeds implantationwere expected survival time not more than the non-prior chemotherapeutic ones. But thepatients in the post-chemotherapeutic subgroup, could be expected survival time obviouslymore than the non-post chemotherapeutic subgroup. It proved that iodine125were avail toimprove the pain effectively, but not obvious improving survival time. However iodine125implantation combination with the post chemotherapy not only remitted the pain but alsoprolonged the survival time. However it didn′t prolong the progression-free survival(PFS). |
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