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Cryosurgery with combination of 125iodine seed implantation for treatment of locally advanced pancreatic cancer

【摘要】:正Purpose:To study the therapeutic value of combination of cryosurgery with 125iodine seed implantation for locally advanced pancreatic cancer.Methods:Thirty eight patients with locally advanced pancreatic cancer,male 28 cases and female 10 cases,with the median age of 57 years old,were enrolled in this study.The diagnosis of disease was based on imaging such as ultrasound,CT and MRI.The disease of 31 cases was confirmed by pathology.Ten cases had metastases of peripancreatic lymph node and 8 cases had liver metastases.The therapy included cryosurgery,which was performed intraoperatively or percutaneously under guidance of ultrasound and /or CT,and 125iodine seed(Syncor Pharmaceutica, Shanghai,China) implantation,which was performed during cryosurgery process or post-cryosurgery under guidance of ultrasound and /CT. Results:Eleven patients received intraoperative cryosurgery and 27 patients received percutaneous cryosurgery. Fourteen patients underwent the second cryosurgery and 3 underwent the third cryosurgery.125Iodine seed implantation was performed during freezing procedure in 29 cases and with 3-7 days after cryosurgery in 9 cases.Fifteen patients in which 13 had metastases of peripancreatic lymph nodes or liver received regional chemotherapy.At the 3 months after therapy,CT follow-up was performed to estimate the tumor respone to therapy.Most of the cases had tumor necrosis of different degree,and complete response(CR) of tumor was seen in 23.6%of patients,partial response(PR),in 42.1%, stable disease(SD),in 26.3%,and progressive disease(PD),in 7.9%.The adverse effects associated with cryosurgery mainly included pain of upper abdomen and increased serum amylase activity.Acute pancreatitis was seen in 5 patients in whom one presented hemorrhagic type of pancreatitis.All adverse effects were controlled by medical management with no poor outcome.There were no therapy-related mortality.During the followed-up of median 16 months(range of 5-37) median overall survival was 12 months and there were 20 cases(52.6%) whose survival was 12 months or more. Overall 6-,12-,24-and 36-month survival rates were 94.7%,49.4%,21.8%and 5.4%,respectively.There were 4 cases that had survival of 24 months or more.The patient with the longest survival is surviving without evidence of recurrence for 3 7 months. Conclusion:The cryosurgery,due to far less invasive than conventional pancreas resection,and the low rate of adverse effects,should be choice modality for most of the patients with locally advanced pancreatic cancer.125Iodine seed implantation can destroy the residue survival cancer cells after cryosurgery.Hence,combination of both modalities has a complementary effect.

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