Pilot trial of endoscopic ultrasound-guided interstitial chemoradiation of UICC-T4 pancreatic cancer

Background and aims: Both interstitial brachytherapy and interstitial chemotherapy are effective in improving local controlin patients with local UICC-T4 pancreatic cancer. In this study, we report the results of endoscopic ultrasound (EUS)-guidedinterstitial chemoradiation (EUS-ICR) in patients with advanced pancreatic cancer, with respect to tumor response, clinicalresponse, safety, and complications.Patients and methods: A total of 8 patients (3 men, 5 women; median age of 69) with T4 pancreatic adenocarcinoma were thesubjects of this study. A mean of 18 radioactive seeds and 36 intratumoral implants for sustained delivery of 5-fluorouracil ineach patient were implanted into the tumors using EUS-guided needle puncture. The mean total implanted radioactive activitywas 13.68 mCi, the mean total dose of intratumoral 5-fluorouracil was 3.6 g, and the mean volume of implants was 28 cm3. Theconditions of the patients were followed-up by examination and imaging tests every two months. Clinical endpoints includedthe Karnofsky performance status, pain response, tumor response (assessed by computed tomography and/or EUS), andsurvival.Results: During a median follow-up period of 8.3 months, the objective tumor response was classified as "partial" in 1 of 8patients (with a median duration of partial response of 3 months), "minimal " in 2 patients, and indicative of "stable disease " in3 of 8 patients. Clinical benefit was shown in 4 of 8 patients, which was mostly due to pain reduction, and lasted for 3.5 months.No local complications or hematologic toxicity occurred.Conclusions: EUS-ICR had a moderate local anti-tumor effect, showed some clinical benefits in 4 of the 8 patients, and was welltolerated by all the patients in this study.