冷冻加放射性碘粒子植入治疗局部进展型胰腺癌

Combination of cryosurgery with iodine-125 seed implantation for locally advanced pancreatic carcinoma

目的探讨术中或经皮冷冻加^125I粒子植入对局部进展型胰腺癌的治疗价值。方法对38例经过综合评价被认为不能接受手术切除的局部进展型胰腺癌采用手术中或经皮冷冻加^125I粒子植入方法进行治疗。^125I粒子植入系在手术直视下或在超声或CT引导下经皮穿刺完成。8例患者人院前接受过4—6个周期化疗。治疗后3个月做CT评价肿瘤治疗反应。结果11例患者接受术中冷冻，27例接受经皮冷冻，其中14例接受2次冷冻，3例接受3次冷冻。29例在冷冻的同时行肿瘤内^125I粒子植入，9例在术后于超声或CT引导下行^125I粒子植入。15例（其中13例伴胰周淋巴结或肝转移）患者行区域动脉化疗。CR、PR、SD和PD分别为9例、16例、10例和3例。20例（52．6％）患者出现上腹痛，16例（42．1％）血清淀粉酶升高，5例（13．2％）并发AP，其中1例为SAP，均经保守治疗痊愈。无治疗相关性死亡。随访5—37月，中位生存期12个月，6、12、24和36个月总生存率分别为94．7％、49．4％、21．8％和5．4％。接受化疗患者的6、12、24和36个月生存率分别为93．3％、26．6％、0和0，未接受化疗者生存率分别为95．6％、65．9％、19．8％和9．9％，两组相差显著（P〈0．01）。生存期最长的2例分别为31和37个月，目前无任何复发证据。病死29例，12个月内共病死15例。结论对大多数胰腺癌尤其不能手术切除患者，冷冻治疗有良好疗效，不良反应发生率较低。在冷冻同时或其后加用^125I粒子植入，与冷冻治疗有相辅相成之效。

Objective To investigate the role of combination of cryosurgery with iodine-125 seed implantation for locally advanced pancreatic cancer. Methods Thirty eight patients with locally advanced pancreatic cancer unfit for surgery after a comprehensive evaluation, were enrolled in this study. The therapy included cryosurgery, which was performed intraoperatively or percutaneously under guidance of ultrasound or CT, and iodine-125 seed implantation, which was performed during cryosurgery process or post-cryosurgery under guidance of ultrasound or CT. Eight patients received 4 - 6 cycles of chemotherapy, 3 months later, CT scans were performed to estimate the response. Results Eleven patients received intraoperative cryosurgery and 27 patients received pereutaneous cryosurgery. Fourteen patients underwent the second cryosurgery and 3 underwent the third cryosurgery. Iodine-125 seed implantation was performed during freezing procedure in 29 cases and after cryosurgery in 9 cases. Fifteen patients in which 13 had metastases of peripancreatic lymph nodes or liver received regional arterial chemotherapy. The complete response （CR） of tumor was seen in 9 cases, partial response （PR） in 16 cases, stable disease （SD） in 10 cases, and progressive disease （PD） in 3 cases. The adverse effects associated with cryosurgery mainly included upper abdominal pain and hyperamylasemia. Acute pancreatitis was seen in 5 patients in whom one presented as severe acute pancreatitis. All adverse effects were controlled by medical management with no mortality. During the followed-up （range of 5 - 37 ）, median overall survival was 12 months and overall 6, 12, 24 and 36 month survival rates were 94.7%, 49.4%, 21.8% and 5.4%, respectively. The overall 6, 12, 24 and 36 month survival rates of patients with chemotherapy were 93.3%, 26.6%, 0% and 0%, respectively. While the overall 6,12, 24 and 36 month survival rates of patients without chemotherapy were 95. 6%, 65. 9% , 19. 8% and 9. 9% , respectively. The difference was statistical significant （ P 〈 0.01 ）. Two patients had survived for 37 months and 31 months without evidence of recurrence. Twenty-nine patients died, and 15 patients died within 12 months. Conclusions The cryosurgery should be an treatment option for most of the patients with locally advanced pancreatic cancer for excellent therapeutic effect and low rate of adverse effects. Iodine-125 seed implantation during or after cryosurgery could reinforce the effect of cryosurgery.