| Objective:Pancreatic cancer,as a highly malignant tumor,usually has missed the best opportunity for surgical resection when it is discovered,and satisfactory treatment effects cannot be obtained.This article reviews160 cases of pancreatic cancer treated with ultrasound-guided radioactive seed implantation to clarify the advantages of radioactive seed implantation for stage III pancreatic cancer.Methods:Clinical and follow-up data of 160 patients who underwent ultrasound-guided percutaneous radioactive seed implantation as the primary treatment for pancreatic cancer from January 2008 to July 2019 in China-Japan Union Hospital of Jilin University were retrospectively analyzed,Patients were grouped according to tumor size,lymph node metastasis,and tumor invasion to important blood vessels,and survival time statistics were obtained.TNM tumor classification was stage I in 10 patients,stage II in 18,stage III in 95,and stage IV in 37.Eighty-four patients had developed jaundice when seeking medical care and all of them were treated for jaundice before radioactive seed implantation.The treatment included percutaneous transhepatic cholangiography and stent implantation in 55,percutaneous transhepatic biliary drainage in 21,and biliary drainage under duodenoscope in 8 patients.All 160 patients underwent pathological examination before operation and were diagnosed as pancreatic ductal adenocarcinoma;all patients received radioactive seed implantation as the primary treatment after admission,and no other anti-tumor therapy was performed before seed implantation;all patients were 1 week after operation All patients had finished more than two cycles of gemcitabine-based chemotherapy after the seed implantation therapy.The patient came to the hospital for re-examination 1,2,4months after the radioactive seed implantation treatment,and performed chest CT,abdominal CT and/or abdominal ultrasound and CA19-9examination to understand the treatment effect and determine whether the patient has local tumor progression,recurrence,or metastasis Wait for the situation,and check it every 3-6 months for the next 2 years.Results:All patients completed the operation according to the preoperative plan.The P-value for survival time was 0.0022 between stages I and II,0.8230 between stages II and III,and 0.0026 between stages III and IV;0.0115 between stage T4-any N-M0 and stage I and 0.6561 between stage T4-any N-M0 and stage II;0.6921 between stage IA and group No.4;0.1442 between stage IB and group No.7;0.1151 between stage IIA and group No.10;and 0.1138 between stage IIB and combined data of groups No.5,No.8,No.11.The mean survival time was 35.23 ± 19.67(months)for stages I,II,and III patients with maximum tumor diameter of ≤2 cm(group D1: IA,No.1,No.4,No.5,and No.6).The mean survival time was 13.60 ± 7.94(months)in patients with maximum tumor diameter of >2 cm and ≤4 cm(group D2: IB,IIB-T2N1M0,No.2,No.7,No.8,and No.9).The mean survival time was 10.02 ± 4.79(months)in patients with maximum tumor diameter of >4 cm(group D3: IIA,IIB-T3N1M0,No.3,No.10,No.11,and No.12).The P-value was <0.0001 between groups D1 and D2 and0.0054 between groups D2 and D3.The mean survival time was 17.24 ± 12.82(months)for stages I,II,and III patients without lymph node metastasis(group N0: IA,IB,IIA,No.4,No.7,and No.10);9.63 ± 3.79(months)in patients with 1–3regional lymph node metastases(group N1: IIB,No.5,No.8,and No.11);and 7.41 ± 2.50(months)in patients with ≥4 regional lymph node metastases(group N2: No.1,No.2,No.3,No.6,No.9,and No.12).The P-value was 0.0121 between groups N0 and N1 and 0.0179 between groups N1 and N2.The mean postoperative survival time(months)was 24.80 for stage I,12.89 for stage II,13.51 for stage III,and 7.49 for stage IV patients,and the difference between stage II and stage III patients was not statistically significant.The efficacy of radioactive seed implantation therapy for pancreatic cancer was strongly associated with tumor size and number of lymph node metastases,but not significantly associated with tumor invasion to blood vessels.Conclusions:Interstitial implantation of radioactive seeds is an effective treatment for patients with pancreatic cancer who cannot be surgically removed and cannot tolerate surgery.Compared with conventional surgical methods,implantation of radioactive seeds is a minimally invasive treatment for patients’ lives.And the quality of life has been significantly improved,especially for the treatment of stage III unresectable pancreatic cancer,which has significant advantages and can significantly improve the survival time of patients. |
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