Clinical research on ultrasound-guided percutaneous laser ablation for advanced pancreatic cancer

doi:10.3877/cma.j.issn.2095-5782.2019.01.013

Abstract

Abstract:

Objective:

To investigate the feasibility, safety and short-term efficacy of ultrasound-guided percutaneous laser ablation for advanced pancreatic cancer.

Methods:

A prospective study was performed. Seven patients with advanced pancreatic cancer, who were admitted to our hospital from September 2016 to October 2017, were treated with ultrasound-guided percutaneous laser ablation. Laboratory indicators (CA-199, serum lipase, amylase and blood glucose) before and after ablation, pain, quality of life scores, postoperative ablation-related adverse events and major complications were observed.

Results:

All procedures were successfully completed by laser ablation with a technical success rate of 100%. There was no significant difference in CA-199, serum lipase, amylase and blood glucose levels before and after laser ablation (P>0.05) . The patient's physical function was improved after 1 month of surgery [ (50.0±0) points vs. (30.8±3.4) points], and the pain was relieved compared with preoperative[ (26.7±11.3) points vs. (61.9±16.3) points.], which had significant statistically difference (P<0.05) . The median overall survival time was 10 months (95%CI: 5-13 months) . During the median follow-up period of 9.7 (6 to 15) months, 4 patients were treated with 6.5, 7.7 and 9.4 months, respectively, and died in 12.5 months, the remaining 3 cases were still alive during the follow-up period. There were no major complications related to ablation after operation. Gastrointestinal-related adverse reactions including nausea, abdominal pain and loss of appetite within 3 d after surgery were improved after symptomatic treatment.

Conclusions:

Laser ablation is effective in the treatment of advanced pancreatic cancer, with high safety and short-term curative effect. It is worthy of further clinical promotion.

Key words: Laser ablation, Ultrasound-guided, Advanced pancreatic cancer, 3D visualization

Chao An, Ping Liang, Jie Yu. Clinical research on ultrasound-guided percutaneous laser ablation for advanced pancreatic cancer[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2019, 07(01): 64-69.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhjrfsxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-5782.2019.01.013

https://zhjrfsxdzzz.cma-cmc.com.cn/EN/Y2019/V07/I01/64

Figures/Tables 5

References 21

[1]	van Erning FN, Mackay TM, van der Geest LGM，et al. Association of the location of pancreatic ductal adenocarcinoma（head，body，tail）with tumor stage，treatment，and survival: a population-based analysis[J]. Acta Oncol，2018:1-8.
[2]	Sahin IH, Elias H, Chou JF，et al. Pancreatic adenocarcinoma: insights into patterns of recurrence and disease behavior[J]. BMC Cancer，2018，18(1):769.
[3]	He C, Zhang Y, Cai Z，et al. Overall survival and cancer-specific survival in patients with surgically resected pancreatic head adenocarcinoma: A competing risk nomogram analysis[J]. J Cancer，2018，9(17):3156-3167.
[4]	Tempero MA, Malafa MP, Al-Hawary M，et al. Pancreatic Adenocarcinoma，Version 2.2017，NCCN Clinical Practice Guidelines in Oncology[J]. J Natl Compr Canc Netw，2017，15(8):1028-1061.
[5]	Wang WQ, Liu L, Ni QX，et al. Guidelines for the diagnosis and treatment of pancreatic adenocarcinoma（2018 edition）: A standardized procedure recommended in China[J]. HBPD INT，2018，17(5):383-384.
[6]	Al-Husseini MJ, Saad AM, Turk T，et al. Impact of prior malignancy on survival outcomes of stage IV pancreatic adenocarcinoma: SEER-Based Cohort[J]. J Gastrointest Cancer，2018. [Epub ahead of print]
[7]	Huang KW, Yang PC, Pua U，et al. The efficacy of combination of induction chemotherapy and irreversible electroporation ablation for patients with locally advanced pancreatic adenocarcinoma[J]. J Surg Oncol，2018，118(1):31-36.
[8]	D'Onofrio M, Barbi E, Girelli R，et al. Variation of tumoral marker after radiofrequency ablation of pancreatic adenocarcinoma[J]. J Gastrointest Oncol，2016，7(2):213-220.
[9]	Nabavizadeh A, Payen T, Saharkhiz N，et al. Technical Note: In vivo Young's modulus mapping of pancreatic ductal adenocarcinoma during HIFU ablation using harmonic motion elastography（HME）[J]. Med Phys，2018，45(11):5244-5250.
[10]	Xu JB, Yang XC, Guo JH，et al. Serum nerve growth factor level indicates therapeutic efficacy of 125I seed implantation in advanced pancreatic adenocarcinoma[J]. Eur Rev Med Pharmacol Sci，2015，19(18):3385-3390.
[11]	Pacella CM. Ultrasound-guidedpercutonous laser ablation of liver tissue in a rabbit model[J]. European Radiology，1993，3(5):479-479.
[12]	Tian G, Jiang T. US-guided percutaneous laser ablation of refractory metastatic retroperitoneal lesions: A care-compliant case report[J]. Medicine（Baltimore），2017，96(15):e6597.
[13]	Morton LM, Kerns SL, Dolan ME. Role of germline genetics in identifying survivors at risk for adverse effects of cancer treatment[J]. Am Soc Clin Oncol Educ Book，2018，(38):775-786.
[14]	Morse B, Jeong D, Ihnat G，et al. Pearls and pitfalls of response evaluation criteria in solid tumors（RECIST）v1.1 non-target lesion assessment[J]. Abdom Radiol（NY），2018. [Epub ahead of print]
[15]	Mizota A, Takasoh M, Kobayashi K，et al. Internal sclerostomy with the Er: YAG laser using a gradient-index（GRIN）endoscope[J]. Ophthalmic Surg Lasers，2002，33(3):214-220.
[16]	Moyer MT, Sharzehi S, Mathew A，et al. The safety and efficacy of an alcohol-free pancreatic cyst ablation protocol[J]. Gastroenterology，2017，153(5):1295-1303.
[17]	Date RS, Siriwardena AK. Radiofrequency ablation of the pancreas. II: Intra-operative ablation of non-resectable pancreatic cancer. A description of technique and initial outcome[J]. JOP，2005，6(6):588-592.
[18]	Spiliotis JD, Datsis AC, Michalopoulos NV，et al. Radiofrequency ablation combined with palliative surgery may prolong survival of patients with advanced cancer of the pancreas[J]. Langenbecks Arch Surg，2007，392(1):55-60.
[19]	Zou YP, Li WM, Zheng F，et al. Intraoperative radiofrequency ablation combined with 125 iodine seed implantation for unresectable pancreatic cancer[J]. World J Gastroenterol，2010，16(40):5104-5110.
[20]	Schena E, Saccomandi P, Fong Y. Laser ablation for cancer: past，present and future[J]. J Funct Biomater，2017，8(2):E19.
[21]	Wang ZJ, Behr S, Consunji MV，et al. Early Response Assessment in Pancreatic Ductal Adenocarcinoma Through Integrated PET/MRI[J]. AJR Am J Roentgenol，2018，211(5):1010-1019.

病理类型		例数	治疗参数	数值
?	中分化腺癌	4	光纤数量（个）	1.6±0.5
?	低分化神经内分泌癌	3	消融功率（W）	5
血管包绕（>180°）位置		?	消融能量（kJ）	9.5±1.8
?	肠系膜上动脉	3	消融点数（个）	2.6±0.9
?	肠系膜上静脉	3	随访时间（月）	9.7（6～15）
?	腹腔干	4	术后住院时间（d）	5.0±0.5
?	脾动脉	3	住院费用（元）	47 254.7
?	脾静脉	2	?	?

病理类型		例数	治疗参数	数值
?	中分化腺癌	4	光纤数量（个）	1.6±0.5
?	低分化神经内分泌癌	3	消融功率（W）	5
血管包绕（>180°）位置		?	消融能量（kJ）	9.5±1.8
?	肠系膜上动脉	3	消融点数（个）	2.6±0.9
?	肠系膜上静脉	3	随访时间（月）	9.7（6～15）
?	腹腔干	4	术后住院时间（d）	5.0±0.5
?	脾动脉	3	住院费用（元）	47 254.7
?	脾静脉	2	?	?

时点	CA-199（U/ml）	血清脂肪酶（U/L）	血清淀粉酶（U/L）	血糖（mmol/L）
消融术前	4.8（0.6～163.8）	23.4（10.1～69）	156.2（27.6～319.2）	5.6（4.9～23.1）
消融术后	4.0（0.6～363.3）	19.2（10.1～74.5）	80.7（27.6～278.1）	6.2（5.1～9.0）
Z值	10.371	3.291	21.512	1.921
P值	0.16	0.51	0.08	0.62

时点	CA-199（U/ml）	血清脂肪酶（U/L）	血清淀粉酶（U/L）	血糖（mmol/L）
消融术前	4.8（0.6～163.8）	23.4（10.1～69）	156.2（27.6～319.2）	5.6（4.9～23.1）
消融术后	4.0（0.6～363.3）	19.2（10.1～74.5）	80.7（27.6～278.1）	6.2（5.1～9.0）
Z值	10.371	3.291	21.512	1.921
P值	0.16	0.51	0.08	0.62

时点	躯体功能	角色功能	情绪功能	认知功能	社交功能	整体生活质量	疲乏	头晕和呕吐
术前	30.8±3.4	41.7±11.8	27.7±3.8	41.3±11.5	60±0	54.9±32.9	51.2±16.1	73.4±14.9
术后1个月	50.0±0^a	46.6±6.7	40.1±18.0	60.0±28.0	60±0	58.4±31.5	41.1±25.0	43.3±38.9
术后3个月	40.4±15.4	40.7±12.7	31.3±1.8	41.3±11.5	60±0	45.0±42.1	64.0±12.9	53.4±29.8
F值	12.102	3.172	3.734	7.812	0	2.186	3.921	7.821
P值	0.001	0.208	0.243	0.226	1.000	0.239	0.374	0.121
时点	疼痛	呼吸困难	失眠	食欲缺乏	便秘	腹泻	经济困难
术前	61.9±16.3	65.4±13.7	65.2±37.9	56.7±30.2	51.7±30.3	0	10.1±22.3
术后1个月	26.7±11.3^a	40.1±20.0	30.1±36.7	30.1±24.5	25.4±31.6	10.2±25.2	10.2±22.3
术后3个月	21.7±10.8^a	65.3±12.6	45.1±41.1	60.1±33.5	46.7±31.4	0	30.4±27.3
F值	17.205	3.892	5.723	8.921	11.230	10.267	7.843
P值	0.023	0.142	0.184	0.178	0.095	0.104	0.185

Please choose a citation manager

Content to export