BACKGROUND： CT-guided high-dose-rate brachytherapy（CT-HDRBT） is an interventional radiologic technique for local ablation of primary and secondary malignomas applying a radiation source through a brachycatheter per...BACKGROUND： CT-guided high-dose-rate brachytherapy（CT-HDRBT） is an interventional radiologic technique for local ablation of primary and secondary malignomas applying a radiation source through a brachycatheter percutaneously into the targeted lesion. The aim of this study was to assess local tumor control, safety and efficacy of CT-HDRBT in the treatment of liver metastases of pancreatic cancer. METHODS： Twenty consecutive patients with 49 unresectable liver metastases of pancreatic cancer were included in this retrospective trial and treated with CT-HDRBT, applied as a single fraction high-dose irradiation（15-20 Gy） using a 192 Irsource. Primary endpoint was local tumor control and secondary endpoints were complications, progression-free survival and overall survival.RESULTS： The mean tumor diameter was 29 mm（range 10-73）. The mean irradiation time was 20 minutes（range 7-42）. The mean coverage of the clinical target volume was 98%（range 88%-100%）. The mean D100 was 18.1 Gy and the median D100 was 19.78 Gy. Three major complications occurred with post-interventional abscesses, three of which were seen in 15 patients with biliodigestive anastomosis（20%）and overall 15%. The mean follow-up time was 13.7 months（range 1.4-55.0）. The median progression-free survival was 4.9 months（range 1.4-42.9, mean 9.4）. Local recurrence occurred in 5（10%） of 49 metastases treated. The median overall survival after CT-HDRBT was 8.6 months（range 1.5-55.3）. Eleven patients received chemotherapy after ablation with a median progression-free survival of 4.9 months（mean 12.9）. Nine patients did not receive chemotherapy after intervention with a median progression-free survival of 3.2 months（mean 5.0）. The rate of local tumor control was 91% in both groups after 12 months.CONCLUSION： CT-HDRBT was safe and effective for the treatment of liver metastases of pancreatic cancer.展开更多
Background： We examined the impact of adjuvant modalities on resected pancreatic and periampullary adenocarcinoma（PAC）.Methods： A total of 563 patients who were curatively resected for PAC were retrospectively ana...Background： We examined the impact of adjuvant modalities on resected pancreatic and periampullary adenocarcinoma（PAC）.Methods： A total of 563 patients who were curatively resected for PAC were retrospectively analyzed between 2003 and 2013.Results： Of 563 patients, 472 received adjuvant chemotherapy（CT） alone, chemoradiotherapy（CRT） alone, and chemoradiotherapy plus chemotherapy（CRT-CT） were analyzed. Of the 472 patients, 231 were given CRT-CT, 26 were given CRT, and 215 were given CT. The median recurrence-free survival（RFS） and overall survival（OS） were 12 and 19 months, respectively. When CT and CRT-CT groups were compared, there was no significant difference with respect to both RFS and OS, and also there was no difference in RFS and OS among CRT-CT, CT and CRT groups. To further investigate the impact of radiation on subgroups, patients were stratified according to lymph node status and resection margins. In node-positive patients, both RFS and OS were significantly longer in CRT-CT than CT. In contrast, there was no significant differencebetween groups when patients with node-negative disease or patients with or without positive surgical margins were considered.Conclusions： Addition of radiation to CT has a survival benefit in patients with node-positive disease following pancreatic resection.展开更多
Introduction: Autoimmune pancreatitis type 1 (AIP) is a rare condition characterized by inflammatory and fibrosing involvement of the pancreas, associated with elevated serum IgG4 and potential involvement of other or...Introduction: Autoimmune pancreatitis type 1 (AIP) is a rare condition characterized by inflammatory and fibrosing involvement of the pancreas, associated with elevated serum IgG4 and potential involvement of other organs. It often mimics a malignant tumor with which the differential diagnosis is often difficult. Observation: We report a case of AIP type 1, in a 70-year-old patient, with a heavy history of arterial hypertension, insulin-induced type II diabetes, overweight, gastric ulcer, ischemic heart disease with triple bypass, COPD, revealed by intense abdominal pain and acute evolution. The diagnosis was evoked on imaging, in front of an aspect of “sausage pancreas”, with delayed contrast enhancement of the pancreas, loss of lobulations, and the presence of a fibrous peripancreatic shell. The biological and histological assessment confirmed the diagnosis and avoided inappropriate surgical treatment. Conclusion: AIP type 1 is a rare pathology whose diagnosis is difficult. Only a perfectly interpreted imagery can evoke it. The biological assessment, in particular, the elevation of the serum level of IgG4 and the histology make it possible to confirm the diagnosis. The challenge in its management is to avoid unnecessary surgery and/or inappropriate treatments. Imaging, in this context, plays a preponderant role, in particular, thanks to the dynamic injection sequences of gadolinium chelates on MRI which suggest the fibro-inflammatory nature of pancreatic lesions.展开更多
文摘BACKGROUND： CT-guided high-dose-rate brachytherapy（CT-HDRBT） is an interventional radiologic technique for local ablation of primary and secondary malignomas applying a radiation source through a brachycatheter percutaneously into the targeted lesion. The aim of this study was to assess local tumor control, safety and efficacy of CT-HDRBT in the treatment of liver metastases of pancreatic cancer. METHODS： Twenty consecutive patients with 49 unresectable liver metastases of pancreatic cancer were included in this retrospective trial and treated with CT-HDRBT, applied as a single fraction high-dose irradiation（15-20 Gy） using a 192 Irsource. Primary endpoint was local tumor control and secondary endpoints were complications, progression-free survival and overall survival.RESULTS： The mean tumor diameter was 29 mm（range 10-73）. The mean irradiation time was 20 minutes（range 7-42）. The mean coverage of the clinical target volume was 98%（range 88%-100%）. The mean D100 was 18.1 Gy and the median D100 was 19.78 Gy. Three major complications occurred with post-interventional abscesses, three of which were seen in 15 patients with biliodigestive anastomosis（20%）and overall 15%. The mean follow-up time was 13.7 months（range 1.4-55.0）. The median progression-free survival was 4.9 months（range 1.4-42.9, mean 9.4）. Local recurrence occurred in 5（10%） of 49 metastases treated. The median overall survival after CT-HDRBT was 8.6 months（range 1.5-55.3）. Eleven patients received chemotherapy after ablation with a median progression-free survival of 4.9 months（mean 12.9）. Nine patients did not receive chemotherapy after intervention with a median progression-free survival of 3.2 months（mean 5.0）. The rate of local tumor control was 91% in both groups after 12 months.CONCLUSION： CT-HDRBT was safe and effective for the treatment of liver metastases of pancreatic cancer.
文摘Background： We examined the impact of adjuvant modalities on resected pancreatic and periampullary adenocarcinoma（PAC）.Methods： A total of 563 patients who were curatively resected for PAC were retrospectively analyzed between 2003 and 2013.Results： Of 563 patients, 472 received adjuvant chemotherapy（CT） alone, chemoradiotherapy（CRT） alone, and chemoradiotherapy plus chemotherapy（CRT-CT） were analyzed. Of the 472 patients, 231 were given CRT-CT, 26 were given CRT, and 215 were given CT. The median recurrence-free survival（RFS） and overall survival（OS） were 12 and 19 months, respectively. When CT and CRT-CT groups were compared, there was no significant difference with respect to both RFS and OS, and also there was no difference in RFS and OS among CRT-CT, CT and CRT groups. To further investigate the impact of radiation on subgroups, patients were stratified according to lymph node status and resection margins. In node-positive patients, both RFS and OS were significantly longer in CRT-CT than CT. In contrast, there was no significant differencebetween groups when patients with node-negative disease or patients with or without positive surgical margins were considered.Conclusions： Addition of radiation to CT has a survival benefit in patients with node-positive disease following pancreatic resection.
文摘Introduction: Autoimmune pancreatitis type 1 (AIP) is a rare condition characterized by inflammatory and fibrosing involvement of the pancreas, associated with elevated serum IgG4 and potential involvement of other organs. It often mimics a malignant tumor with which the differential diagnosis is often difficult. Observation: We report a case of AIP type 1, in a 70-year-old patient, with a heavy history of arterial hypertension, insulin-induced type II diabetes, overweight, gastric ulcer, ischemic heart disease with triple bypass, COPD, revealed by intense abdominal pain and acute evolution. The diagnosis was evoked on imaging, in front of an aspect of “sausage pancreas”, with delayed contrast enhancement of the pancreas, loss of lobulations, and the presence of a fibrous peripancreatic shell. The biological and histological assessment confirmed the diagnosis and avoided inappropriate surgical treatment. Conclusion: AIP type 1 is a rare pathology whose diagnosis is difficult. Only a perfectly interpreted imagery can evoke it. The biological assessment, in particular, the elevation of the serum level of IgG4 and the histology make it possible to confirm the diagnosis. The challenge in its management is to avoid unnecessary surgery and/or inappropriate treatments. Imaging, in this context, plays a preponderant role, in particular, thanks to the dynamic injection sequences of gadolinium chelates on MRI which suggest the fibro-inflammatory nature of pancreatic lesions.
