Primary

Clinical

Study

ofCT-guidedIodine-125

SeedImplantation

Therapy

inPatients

with

AdvancedPancreatic

Cancer上海交通大學(xué)醫(yī)學(xué)院附屬瑞金醫(yī)院盧灣分院王忠敏1Brachytherapy21898年居里夫人發(fā)現(xiàn)鐳1905年即進(jìn)行了第1例鐳針插管治療1930年P(guān)aterson及Parker建立了曼切斯特（Manchester）系統(tǒng)1935年小居里夫婦發(fā)現(xiàn)了人工放射性同位素80年代中期，現(xiàn)代近距離治療迅速發(fā)展生物學(xué)優(yōu)勢(shì)（外放療相比）腫瘤局部治療的持續(xù)時(shí)間長(zhǎng)放射治療的劑量較低對(duì)周圍正常組織的損傷小對(duì)腫瘤細(xì)胞的殺傷力強(qiáng)3Implant

radioactive

seeds

into

tumorsEmit

continueous

low

energyγ

raysInjury

of

tissues

and

cells4Cell

death

and

mutationleading

to

cancerInteract

with

biomacromoleculeAnimalexperimentClinicalresearch5

Human

pancreatic

cancer

Sw1990

cell

BABL/c

was

inoculated

into

the

dorsal

side

of

right

lowerextremity

inguinal

region

of

nude

mice

Passaged

for

3

tims

subcutaneously,

initiate

the

experimentsafter

tumor

formationwas

stablized6Experimental

designSubcutaneous

pancreatic

cancerxenograft in

nude

miceSeed

implantation

groupControl

groupExperimental

method7Change

of

xenograft

volume

in

nudemice8Comparison

of

tumor

inhibition

rate910Obvious

liquefaction

necrosiscan

be

seen

in

thecenteralarea

of

Experimental

grouptumor,

there

are

sparse

cellsaroud

the

necrosis

area(×100)HE

stainingThere

is

no

or

little

necrosisarea

in

center

of

control

grouptumor,

there

are

multipletumor

cells(×100)11Experimental

group

positive

TK1staining

cells

are

exiguous（×200）Control

group

positiveTK1staining

cells

are

abundent（×200）HE

staining1213

碘-125放射粒子組織間植入治療屬放射治療，對(duì)周圍正常器官組織無(wú)明顯放射損傷

裸鼠移植瘤組織植入碘-125粒子后，實(shí)驗(yàn)組心、肺、肝、腎、脾臟外觀大致正常，病理檢查未見(jiàn)明顯放射性炎癥表現(xiàn)14Preliminary

resultZM.

Wang

MD, Shanghai

Ruijin

Hospital15Introduction

Pancreatic

cancer

is

a

devastating

diseaseand

the

prognosis

remainspoor

Few

patients

are

eligible

for

curative

surgicalresection

Alternative

therapeutic

options

are

in

demandTraditional

therapy

vs.

Externalirradiation

therapy

vs.

percutaneousseed

implantationZM.

Wang

MD, Shanghai

Ruijin

Hospital16nsensitivee

systemicminimal25utionforExternal

irrtopancreatiside

effectsRadioactivesurgical

traThe

most

c125I

placemrecurrent

tuforThe

aim

of

tpancreaticladiation

therapy

was

regarded

as

ic

cancer

and

associated

with

moriodine-125

seed

implantation

hasuma

and

fewcomplicationsommonly

used

isotope

is

iodine-1ent

was

routinely

used

at

our

institmors

at

various

siteshis

study

was

to

test

its

feasibilityesionsCurrent

Controversies17Methods

and

materials18Patient

populationDecember

2004

to

August

2007,

31

consecutive

patientswere

included

in

this

prospective,

nonrandomized

studyPatients

were

diagnosed

by

CT

or

MRI

with

histologicalconfirmation

of

the

diagnosis

byFNAAll

patients

enrolled

displayed

contraindications

tosurgery

or

had

rejected

surgical

treatment

duetopersonal

reasons11th

IO

2010,

May

23ZM.

Wang

MD, Shanghai

Ruijin

Hospital19Methods

and

materials

The

total

volume

of

each

tumor

was

calculated

with

thetreatment

planning

system

(TPS)

before

implantation

The

expected

number

of

implanted

seed

was

calculatedaccording

to

the

modified

level

formula

Patients

were

kept

in

ourradiooncology/interventionalward

with

an

usual

stay

of

4

full

daysMethods

and

materialsClinical

benefit

response

was

derived

frommeasurement

of

pain,

functional

impairment

andweight

lossPatients

were

examined

by

CT

after

the

operationResponse

rate

was

defined

as

the

sum

of

CR

andPRLocal

tumor

control

was

defined

as

the

absence

oftumor

progression

(SD+PR+CR)20Methods

and

materials10

patients

received

concurrent

chemotherapywith

arterial

infusion

of

gemcitabin

and5-fluorouracil

(5-Fu)Chemotherapy

was

initiated

one

week

after

andrepeated

up

to

fourcyclesFollow-up

visits

at

1

month,

3

month,

and

every3

months

for

clinical

examination,

bloodsampling,

and

CT

examinationZM.

Wang

MD, Shanghai

Ruijin

Hospital21適應(yīng)癥實(shí)體瘤（如前列腺癌）的根治性治療實(shí)體瘤術(shù)后殘余組織的預(yù)防性治療轉(zhuǎn)移性腫瘤病灶或術(shù)后孤立性腫瘤轉(zhuǎn)移灶而失去手術(shù)價(jià)值者無(wú)法手術(shù)的原發(fā)腫瘤的姑息性治療22禁忌證放射性治療不宜(如血液病等)及有麻醉禁忌等病灶范圍廣泛惡液質(zhì)、全身衰竭腫瘤部位有活動(dòng)性出血、壞死或潰瘍嚴(yán)重糖尿病23ResultsIodine-125

Therapy

in

Advanced

Pancreatic

Cancer24Change

of

Karnofsky

physical

score

%

(cases)ResultsChange

of

pain

score

%

(cases)Iodine-125

Therapy

in

Advanced

Pancreatic

Cancer25Results26

Overall

responding

rate

(CR+PR)

=61.3%Local

tumor

control

rate

was

90.3%

Median

survival

time

for

the

whole

group

was10.31

months

Median

survival

time

for

pure

seeds

implantation(21

cases)

was

7

months

median

survival

time

for

drug-seeds

combinedwas

11monthPre-implant

CTscan(Case

one)ZM.

Wang

MD, Shanghai

Ruijin

Hospital27Post-implantCT

scanZM.

Wang

MD, Shanghai

Ruijin

Hospital28Pre-implant

CTscan(Case

Two)29Post-implant

CT

scan30Post-implant

CT

scan31Pre-implant

CTscan

(Case

Three)32Post-implant

CT

scan33Pre-implant

CTscan

(Case

Four)34Post-implant

CT

scan35Post-implant

CT

scan36Complications37

No

serious

complications

encountered

2

seeds

of

radioactive

125I

found

tomigrateto

liver

in

2patients

Leukopenia

and

renal

function

impairmentwere

found

in

4

patients

of

drug-seedscombination

groupIodine-125

Therapy

inadvanced

Pancreatic

CancerDiscussion

Percutaneous

image-guided

seed

implantationhas

attracted

increasing

attention

Extensive

experiences

with

this

technique

hadbeen

collected

targeting

liver

andlungmalignancies

The

most

commonly

used

isotope

is

125I

,

and125I

placement

has

become

a

routine

treatmentfor

recurrent

tumors

at

various

sites

in

ourinstitutionZM.

Wang

MD, Shanghai

Ruijin

Hospital38Technical

points

during

the

procedure39

Patients

fasted

for

24

hours

Ensure

steady

breath

movement

during

the

procedure

Pancreatic

secretion

was

inhibited

Transgress

stomach

is

safer

than

intestine,

avoidingcolon

especially

when

using

large-bore

needles

For

patients

with

jaundice,

do

PTCD

first

Immediate

CT

scan

post

implantation

was

done

to

verifythe

distribution

of

the

seedsZM.

Wang

MD, Shanghai

Ruijin

HospitalDrug-seeds

combinedtherapy40

There

is

data

suggests

that

local

control

ratescan

be

enhanced

by

the

addition

ofchemotherapy

In

our

study

the

median

survival

timebetweenthe

two

groups

reached

statasticallysig