| Objective To investigate the efficacy of High Intensity FocusedUltrasound(HIFU) treatment of advanced pancreatic carcinoma,to comparethe difference between the efficacy of HIFU treatment of carcinoma ofpancreatic head and carcinoma of pancreatic body and tail.Method Select the patients with pancreatic cancer treated with highintensity focused ultrasound in the HIFU centre in our hospital fromJanuary2005to February2012.All patients were confirmed by imaging(CTor MRI) or palliative surgical biopsy.The patients who were compliancewith the following criteriacan can be included in the study: Imagingstudies (CT or MRI) suggest that the lesion of the pancreas atleast≥2.0cm. The patients can not accept or tolerate a redical surgery.Heart,lung liver,renal and coagulation function is not exception,can toleratea general anesthesia and HIFU treatment.④The serum content of totalbilirubin＜2times of upper limit of normal level.⑤Stop accepting otheranti-tumor treatment for at least1month.⑥Do not combine with other primary tumors.⑦Do not exist other contraindications of HIFUtreatment.Divide the40patients into2groups according to the site ofpancreatic tumor.All the20patients with cancer of pancreatic head aredivided into group A,and the others are divided into group B.Both A and Bgroups are treated with HIFU.Frequency of Treatment is0.85Hz,thediameter of focal region is1.1-2mm,the length of focal region is8-9.9ram,the focal length is135mm or147mm,the sound power is80-398W,thetreatment time is348-4500seconds.All patients are given conventionalfluid,anti-infective and fasting2-3days,and using inhibition pancreaticsecretion drugs for3-5days,the patients with high urine and serum amylasemay be appropriate to extend the use of inhibition pancreatic secretiondrugs.Determine the efficacy with pain relief,weight change,MRI imageand survival time after the treatment.Use SPSS17.0to finish the dataapplications.Results After the treatment, the pain response rate (completeresponse+partial response) of group A is53.8%,while it is70%in thegroup B,rank sum test of the changes in the amount of the painkiller in thecases between two groups is significant difference (P＜0.05).The weightincrease of group A is45%, while it is60%in the group B.The weightchange rank andexamination suggests that it is obviously different(P＜0.05) between the2groups.52.9%of the patients in group A hasdifferent levels of CA19-9decreased,while it is57.1%in the group B,but it is not obviously different (P＞0.05) between the2groups.Two weeks afterthe treatment,abdominal MR shows that all lesions have varying degrees ofall patients in T2weighted images and blood supply of each treatment areasdisappears or duction in T1dynamic scanning images,no difference in MRIis found between group A and group B.Till February2012, the mediansurvival time of group A and B is8.4months and6.1months,the meansurvival time is7.3months,higher than3-5months of the mean mediansurvival time of pancreatic cancer.Conclusion HIFU as an important treatment for advanced pancreaticcancer is safe and effective. HIFU can well treat the patients with pain,andeffectively kill the cancer cells,slow the progression of the disease andextend the prolong survival time.After comparing the efficacy of carcinomaof pancreatic head and carcinoma of pancreatic body and tail,we find betterefficacy of carcinoma of pancreatic body and tail in the symptoms ofpain,the median survival time and the improvement of clinicalsymptoms.Because of the particular anatomical location ofpancreas,especially the head of pancreas,the treatment of HIFU must bemore careful to avoid harming the adjacent structure lead to seriouscomplications. |
