Brief Article
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World J Gastroenterol. Oct 28, 2010; 16(40): 5104-5110
Published online Oct 28, 2010. doi: 10.3748/wjg.v16.i40.5104
Intraoperative radiofrequency ablation combined with 125iodine seed implantation for unresectable pancreatic cancer
Yi-Ping Zou, Wei-Min Li, Fang Zheng, Fu-Cheng Li, Hui Huang, Ji-Dong Du, Hao-Run Liu
Yi-Ping Zou, Wei-Min Li, Fang Zheng, Fu-Cheng Li, Hui Huang, Ji-Dong Du, Hao-Run Liu, Department of Hepatobiliary Surgery, Chinese PLA 309 Hospital, Beijing 100091, China
Author contributions: Zou YP proposed the study plan and wrote the draft; Zou YP, Li WM, Zheng F and Li FC performed the radiofrequency ablation and 125iodine seed implantation; Huang H, Du JD and Liu HR made the follow-up, collected and analyzed the data; all authors contributed to the intellectual context and approved the final version.
Correspondence to: Dr. Yi-Ping Zou, Department of Hepatobiliary Surgery, Chinese PLA 309 Hospital, Beijing 100091, China. ypzou_61@sina.com
Telephone: +86-10-66775077 Fax: +86-10-51520952
Received: June 5, 2010
Revised: July 12, 2010
Accepted: July 19, 2010
Published online: October 28, 2010
Abstract

AIM: To evaluate the feasibility, efficacy and safety of intraoperative radiofrequency ablation (RFA) combined with 125iodine seed implantation for unresectable pancreatic cancer.

METHODS: Thirty-two patients (21 males and 11 females) at the age of 68 years (range 48-90 years) with unresectable locally advanced pancreatic cancer admitted to our hospital from January 2006 to May 2008 were enrolled in this study. The tumor, 4-12 cm in diameter, located in pancreatic head of 23 patients and in pancreatic body and tail of 9 patients, was found to be unresectable during operation. Diagnosis of pancreatic cancer was made through intraoperative biopsy. Patients were treated with FRA combined with 125iodine seed implantation. In brief, a RFA needle was placed, which was confirmed by intraoperative ultrasound to decrease the potential injury of surrounding vital structures, a 125iodine seed was implanted near the blood vessels and around the tumor border followed by bypass palliative procedure (cholangio-jejunostomy and/or gastrojejunostomy) in 29 patients.

RESULTS: The serum CA 19-9 level was decreased from 512 ± 86 U/mL before operation to 176 ± 64 U/mL, 108 ± 42 U/mL and 114 ± 48 U/mL, respectively, 1, 3 and 6 mo after operation (P < 0.05). The pain score on day 7 after operation, 1 and 3 mo after combined therapy was decreased from 5.86 ± 1.92 before operation to 2.65 ± 1.04, 1.65 ± 0.88 and 2.03 ± 1.16, respectively, after operation (P < 0.05). The rate of complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD) in 32 patients was 21.8% (7/32), 56.3% (18/32), 15.6% (5/32) and 6.3% (2/32), respectively, 6 mo after operation, with a median overall survival time of 17. 5 mo. The median survival time of patients at stage III was longer than that of those at stage IV (19 mo vs 10 mo, P = 0.0026). The median survival time of patients who received and did not receive chemotherapy after operation was 20 mo and 16 mo, respectively (P = 0.0176). Of the 32 patients, 3 (10.6%) experienced postoperative complications including transient biliary leaks in 2 patients and acute pancreatitis in 1 patient. All the patients recovered well after conservative support treatment.

CONCLUSION: Intraoperative RFA combined with 125iodine seed implantation is a feasible and safe procedure for unresectable pancreatic cancer with acceptable minor complications, and can prolong the survival time of patients, especially those at stage III.

Keywords: Unresectable pancreatic cancer, Radiofrequency ablation, 125iodine seed implantation