Keywords
How to Cite
Abstract
Aim. Improvement of the results of treatment for pancreatic cancer patients who are not eligible to radical surgical intervention.
Material and methods. We present the safety and efficacy results of combined treatment that includes gemcitabine monochemotherapy and high-intensity focused ultrasound therapy (HIFU-therapy) for 35 patients with stage II–IV adenogenic pancreatic cancer with functional status ECOG 0-2, which was conducted in 2017–2020 on the basis of P.A. Herzen Moscow Oncology Research Institute ― the branch of the National Medical Research Center of Radiology. Gemcitabine monochemotherapy was performed at a dosage of 750–1000 mg/m2 on the 1st, 8th, and 15th days every 4 weeks. HIFU-therapy was performed with a device with an ultrasound flow intensity of 2 kW/cm2 within 30–45 minutes, in the scope of 3–8 sessions per course, with acoustic power of 300–600 W.
Results. Partial response of the primary tumor, according to the RECIST criteria, was achieved in 22.9% of patients after 6 courses of combined treatment; the disease control rate comprised 68.6%.
A decrease in the pain severity, as compared to the baseline, was registered in 58.3% of patients (6.29±0.38 vs. 4.88±0.39 according to the VAS; p=0.001). The pain control rate was 95.8%.
The median of the overall survival of patients reached 16 months; the median time to progression reached 9 months. 1-, 2- and 3-year overall survival was 71,4%, 17,1%, and 5,7% respectively; a 1-year time to progression was 25,7%.
Grade 3–4 adverse events were detected in 25.7% of patients, local complications of HIFU therapy ― in 34.3% of patients.
Conclusion. The combination of gemcitabine monochemotherapy and HIFU therapy is well tolerated by patients with pancreatic cancer with ECOG 0-2 functional status. It is characterized by relatively low toxicity and manageable local complications that do not require treatment interruption. Combined treatment performed for patients with pancreatic cancer at stages II–IV provides a statistically significant reduction of the level of abdominal pain syndrome by 6 months of treatment and demonstrates promising long-term results.
Aim. Improvement of the results of treatment for pancreatic cancer patients who are not eligible to radical surgical intervention.
Material and methods. We present the safety and efficacy results of combined treatment that includes gemcitabine monochemotherapy and high-intensity focused ultrasound therapy (HIFU-therapy) for 35 patients with stage II–IV adenogenic pancreatic cancer with functional status ECOG 0-2, which was conducted in 2017–2020 on the basis of P.A. Herzen Moscow Oncology Research Institute ― the branch of the National Medical Research Center of Radiology. Gemcitabine monochemotherapy was performed at a dosage of 750–1000 mg/m2 on the 1st, 8th, and 15th days every 4 weeks. HIFU-therapy was performed with a device with an ultrasound flow intensity of 2 kW/cm2 within 30–45 minutes, in the scope of 3–8 sessions per course, with acoustic power of 300–600 W.
Results. Partial response of the primary tumor, according to the RECIST criteria, was achieved in 22.9% of patients after 6 courses of combined treatment; the disease control rate comprised 68.6%.
A decrease in the pain severity, as compared to the baseline, was registered in 58.3% of patients (6.29±0.38 vs. 4.88±0.39 according to the VAS; p=0.001). The pain control rate was 95.8%.
The median of the overall survival of patients reached 16 months; the median time to progression reached 9 months. 1-, 2- and 3-year overall survival was 71,4%, 17,1%, and 5,7% respectively; a 1-year time to progression was 25,7%.
Grade 3–4 adverse events were detected in 25.7% of patients, local complications of HIFU therapy ― in 34.3% of patients.
Conclusion. The combination of gemcitabine monochemotherapy and HIFU therapy is well tolerated by patients with pancreatic cancer with ECOG 0-2 functional status. It is characterized by relatively low toxicity and manageable local complications that do not require treatment interruption. Combined treatment performed for patients with pancreatic cancer at stages II–IV provides a statistically significant reduction of the level of abdominal pain syndrome by 6 months of treatment and demonstrates promising long-term results.
References
Wang H, Liu J, Xia G et al. Survival of pancreatic cancer patients is negatively correlated with age at diagnosis: a population-based retrospective study // Sci Rep. 2020;10:7048. https://doi.org/10.1038/s41598-020-64068-3
Ansari D, Tingstedt B, Andersson B et al. Pancreatic cancer: yesterday, today and tomorrow // FutureOncol. 2016;12(16):1929–4619. https://doi.org/10.2217/fon-2016-0010
Покатаев И.А., Алиева С.Б., Гладков О.А и др. Практические рекомендации по лекарственному лечению рака поджелудочной железы // Злокачественные опухоли: Практические рекомендации RUSSCO. 2019;3s2(9):456–468 [Pokataev IA, Alieva SB, Gladkov OA et al. Practical recommendations for the drug treatment of pancreatic cancer // Malignant tumors: Practical Recommendations RUSSCO. 2019;3s2(9):456–468 (In Russ.)]. https://doi.org/10.18027/2224-5057-2019-9-3s2-456-468
Lee HS, Park SW. Systemic Chemotherapy in Advanced Pancreatic Cancer // GutLiver. 2016;10(3):340–347. https://doi.org/10.5009/gnl15465
Москвичева Л.И., Болотина Л.В. Возможности химиотерапии у больных местно-распространенным и метастатическим аденогенным раком поджелудочной железы // Исследования и практика в медицине. 2020;7(4):118–134 [Moskvicheva LI, Bolotina LV. Possibilities of palliative chemotherapy in patients with locally advanced and metastatic pancreatic cancer // Research and Practical Medicine Journal. 2020;7(4):118–134 (In Russ.)]. https://doi.org/10.17709/2409-2231-2020-7-4-10
Sohal DP, Mangu PB, Khorana AA. Metastatic Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline // J Clin Oncol. 2016;34(23):2784–2796. https://doi.org/10.1200/JCO.2016.67.1412
Zhou YF. HIFU in tumor ablation // World J Clin Oncol. 2011;2(1):8–27. https://doi.org/10.5306/wjco.v2.i1.8
Болотина Л.В., Москвичева Л.И., Корниецкая А.Л. и др. Предварительная оценка эффективности комбинированного лечения с включением HIFU-терапии у больных раком поджелудочной железы // Сибирский онкологический журнал. 2021;20(3):18–27 [Bolotina LB, Moskvicheva LI, Kornietskaya AL et al. Preliminary evaluation of the effectiveness of HIFU-therapy in patients with pancreatic cancer // Siberian Journal of Oncology. 2021;20(3):18–27 (In Russ.)]. https://doi.org/10.21294/1814-4861-2021-20-3-18-27
Tao SF, Gu WH, Gu JC et al. Focused Ultrasound (HIFU) In Combination With Gemcitabine And Oxaliplatin (Gemox) On Treating Elderly Middle And Advanced Pancreatic Cancer // OncoTargets and Therapy. 2019;12:9735–9745. https://doi.org/10.2147/ott.s220299
Zhou D, Lv W, Yan T et al. High-intensity focused ultrasound therapy in combination with gemcitabine for unresectable pancreatic carcinoma // Ther Clin Risk Manag. 2016;12:687–691. https://doi.org/10.2147/tcrm.s90567
Vidal-Jove J, Perich E, Del Castillo MA. Ultrasound Guided High Intensity Focused Ultrasound for malignant tumors: The Spanish experience of survival advantage in stage III and IV pancreatic cancer // Ultrason Sonochem. 2015;27:703–706. https://doi.org/10.1016/j.ultsonch.2015.05.026
Москвичева Л.И., Петров Л.О., Сидоров Д.В. Возможности современных методов абляции при нерезектабельном местно-распространенном раке поджелудочной железы // Исследования и практика в медицине. 2018;5(2):86–99 [Moskvicheva LI, Petrov LO, Sidorov DV. The possibilities of modern methods of ablation in non-resectable locally advanced pancreatic cancer // Research and Practical Medicine Journal. 2018;5(2):86–99 (In Russ.)]. https://doi.org/10.17709/2409-2231-2018-5-2-10
Lau PC, Zheng SF, Ng WT, Yu SC. Inoperable pancreatic adenocarcinoma rendered complete remission by high-intensity focused ultrasound concurrent with gemcitabine-capecitabine chemotherapy: case report and topic review // J Dig Dis. 2012;13(1):60–64. https://doi.org/10.1111/j.1751-2980.2011.00546.x
Adamska A, Domenichini A, Falasca M. Pancreatic Ductal Adenocarcinoma: Current and Evolving Therapies // Int J Mol Sci. 2017;18(7):1338. https://doi.org/10.3390/ijms18071338
Xiong LL, Hwang JH, Huang XB et al. Early clinical experience using high intensity focused ultrasound for palliation of inoperable pancreatic cancer // JOP. 2009;10(2):123–9
Wang K, Zhu H, Meng Z et al. Safety evaluation of high-intensity focused ultrasound in patients with pancreatic cancer // Onkologie. 2013;36(3):88–92. https://doi.org/10.1159/000348530
Sung HY, Jung SE, Cho SH et al. Long-term outcome of high-intensity focused ultrasound in advanced pancreatic cancer // Pancreas. 2011;40(7):1080–6. https://doi.org/10.1097/MPA.0b013e31821fde24
Zhao H, Yang G, Wang D et al. Concurrent gemcitabine and high-intensity focused ultrasound therapy in patients with locally advanced pancreatic cancer // Anticancer Drugs. 2010;21(4):447–52. https://doi.org/10.1097/CAD.0b013e32833641a7
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
© АННМО «Вопросы онкологии», Copyright (c) 2022