High Intensity Focused Ultrasound Ablation Combined With Chemotherapy Based On Genetic Testing In The Treatment Of Advanced Pancreatic Cancer:Preliminary Clinical Observation

OBJECTIVE: Through observing and analyzing the effects and side effects of High intensity focused ultrasound(HIFU) combined with chemotherapy based on genetic testing in the treatment of advanced pancreatic cancer, to discuss the value of High intensity focused ultrasound combined with chemotherapy based on genetic testing in the treatment of advanced pancreatic cancer.METHODS: 21 patients of advanced pancreatic cancer(III 3 cases, IV of 18 cases) in the treatment with High intensity focused ultrasound combined with chemotherapy enrolled in the study. These patients were divided into two groups : 8 patients’ chemotherapy is the choice of chemotherapy based on genetic testing, 13 patients’ chemotherapy is traditional first-line chemotherapy. Observing and recording the side effects,changes in the pain, blood chemistry carefully before and after HIFU treatment of the patient, and side effects of chemotherapy carefully. Using SPSS 19.0 software for the statistical analysis to evaluate the efficacy of HIFU and the differences between the two groups. 2 weeks after HIFU treatment using enhanced MRI or CT for tumor to assess the ablation and calculate the percentage of tumor ablation. Using Kaplan-Meier method to conduct the survivals analysis and to compare the differences of survivals between the two groups of patients.RESULTS: There are 15 patients who with cancer-related pain(VAS visual analogue scale, VAS) in 21 patients before HIFU treatment. Complete remission in 3 patients(20.00%), partial remission in 10 cases(66.67%), stable 1 case(6.67 %) and increased 1 cases(6.67%)after HIFU treatment, the effective rate was 86.67%(complete response + partial response). The pain(VAS score, 4.62 ± 3.67 vs 1.95 ± 1.86) was significantly alleviated before and after the treatment of HIFU(t test, P = 0.000). The tumor ablation rates average was(90.58 ± 6.91)% after HIFU treatment what has a significant positive correlation with survival(Peorson correlation analysis, P = 0.013),The tumor ablation rates was not statistically significant(P = 0.55) in two groups. 21 patients followed up for an average of 8.19 ± 6.10 months, 6 months and 12 month survival rates were 42.9%, 26.7% ~ 33.3%, the median survival time was 6.00(95% CI = 4.22 ~ 7.78) months, the average survival time was 9.92 ± 1.91(95% CI = 6.18 ~ 13.65) months. Genetic testing group and non-group genetic testing 6 months and 12 months survival rates were followed by 62.5% ~ 75% vs 23.1%, 41.7 ~ 62.5% vs 7.7% ~ 15.4%, the median survival time and the average survival time was followed by 17.00(95% CI = 1.58 ~ 32.42) months and 5.00(95% CI = 3.85 ~ 6.15) months, 16.08 ± 3.58(95% CI = 9.07 ~ 23.10) months and 5.70 ± 1.01(95% CI = 3.71 ~ 7.68) months. The survival of genetic testing group was more than non-genetic testing group and was statistically significant(Log Rank, P = 0.015). According to WHO grading standards, the genetic testing group without grade Ⅲ and / or grade Ⅳ side reactions occur, the non-genetic testing group founded grade Ⅲ side reaction in 7 patients(53.85%), the difference was statistically significant(rank and test, P = 0.02) in two groups.CONCLUSIONS:1. HIFU treatment can significantly relieve the pain of advanced pancreatic cancer, it is one of the effective and safe method for the palliative treatment of advanced pancreatic cancer;2.High intensity focused ultrasound combined with chemotherapy based on genetic testing can prolong survival and reduce side effects of chemotherapy that may be one of alternative treatment options in the treatment of advanced pancreatic cancer.