| ObjectiveTo explore the clinical value of irreversible electroporation(IRE)combined with gemcitabine(GEM)in the treatment of locally advanced pancreatic cancer,in order to establish bases in seeking a new therapeutic regimen for pancreatic tumors.MethodsFrom June 2014 to September 2017,follow the criteria of inclusion and exclusion,79 enrolled patients with locally advenced pancreatic cancer were treated at the Hepatobiliary Gastrointestinal Center in our hospital.According to the different treatment methods,they were divided into single drug GEM chemotherapy group,single IRE ablation group and IRE combined GEM treatment group.The change trend of serum amylase,myocardial enzymes and tumor marker CA19-9 were monitored at different time of treatment.To record the adverse reactions and related complications during treatment in each group.Visual analogue scale(VAS)was used to analyze the degree of pain relief in each group after treatment.CT images combined with solid tumors evaluation criteria to compare the tumor volume changes in each group before and after treatment.The short-term survival status was followed up after treatment,which was used to evaluate the clinical efficacy.ResultAfter IRE ablation,the serum amylase level showed a transient increase,which was statistically different from that before IRE ablation(P<0.05).After repeated examinations,it gradually declined and returned to normal level 14 days after operation,and there was no statistical difference compared with preoperative(P>0.05).The myocardial enzymogram level of patients after IRE was in physiological range at different time,and there was no significant change compared with preoperative(P>0.05).The serum amylase and myocardial enzymes in single GEM group were in normal physiological range at different monitoring time points after treatment,and there was no difference compared with those before treatment(P>0.05).The levels of CA19-9 in single IRE ablation group and IRE combined with GEM group were significantly lower than those at preoperative(P<0.01),and the level of CA19-9 in combination group was lower than that in single IRE ablation group(P<0.05).The level of tumor markers in single GEM chemotherapy group increased gradually after treatment,which was different from that before treatment(P<0.05).During IRE ablation,muscle tremor occurred in all patients(100%)and transient elevation of blood pressure in 2 patients(5.1%)without arrhythmia.Acute mild pancreatitis occurred in 4 patients(10.3%)after IRE.No severe complications such as bleeding,thrombosis,gastrointestinal perforation and pancreatic fistula occurred.During GEM chemotherapy,the main adverse reactions were digestive tract symptoms such as nausea and vomiting and other bone marrow depression symptoms such as thrombocytopenia and leukopenia.VAS simulation score showed that the abdominal symptoms of the single IRE ablation group and the combined application group were significantly relieved after 60 days of treatment.However,there was no significant improvement in symptoms in GEM chemotherapy group compared with those before treatment(P>0.05).The effective rate of analgesia in combination group(87.5%)was better than that in single GEM chemotherapy group(30.0%)and single IRE ablation group(60.0%)(P<0.05).CT images showed that the volume of tumors in IRE ablation group(16.50±19.68)cm3 and in combination group(14.17±12.65)cm3 were lower than those in preoperative group 90 days after treatment(P<0.05).The volume level of single GEM chemotherapy group(26.93±17.40)cm3 was not different from that before treatment.At the same time,combined with response evaluation criteria in solid tumors,the remission rate of single IRE ablation group(66.7%)and combined application group(79.2%)were better than that of single GEM chemotherapy group(35%).Follow-up of 16 months after treatment in three groups showed that the average survival time of single GEM chemotherapy group,single IRE ablation group and combined application group was(7.6±3.39)months,(10.2±3.53)months and(11.29±3.69)months,and the median survival time was 7,10 and 12 months.The follow-up results of combined application group were better than those of other two groups(P<0.05).ConclusionIRE combined with GEM can safely and effectively control the local progress of pancreatic tumors,relieve pain symptoms and prolong survival time.Compared with single-drug GEM chemotherapy and single-IRE ablation,the combination of the two methods has better clinical effect,and it can provide a new clinical treatment for locally advanced pancreatic cancer which loses the chance of R0 surgical resection. |
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