Effectiveness and Safety of High-intensity Focused Ultrasound for Pancreatic Cancer: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 LICui-cui ^1,2 , WANGYing-qiang ³ ,  LIYou-ping ¹ , LIXiang-lian ¹

1. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;
2. Department of Respiratory Medicine, Nuclear Industry 416 Hospital, Chengdu 610051, China;
3. Department of Medical Administration, 363 Hospital, Chengdu 610041, China;

Corresponding?author：

LIYou-ping, Email: yzmylab@163.com

Keywords：

High-intensity focused ultrasound; Pancreatic cancer; Effectiveness; Safety; Systematic review

DOI：

10.7507/1672-2531.20140216

Video：

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Objective To explore the effectiveness and safety of high intensity focused ultrasound (HIFU) in the treatment of pancreatic cancer, so as to provide references for its clinical application. Methods PubMed, EMbase, The Cochrane Library (Issue 11, 2013), CBM, CNKI, VIP and WanFang Data were systematically searched up to November 2013 for randomized clinical trials (RCTs) and clinical controlled trials (CCTs) about HIFU in the treatment of pancreatic cancer. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.0. Results A total of 23 studies (19 RCTs and 4 CCTs) were included, of which 14 studies reported safety. The results of meta-analysis showed that:survival rates at the 6th month and the 12th month, overall efficacy and clinical benefit rate in the HIFU plus radiation and chemotherapy group were significantly higher than those in groups treated with three dimensional conformal radiation therapy (3D-CRT) (P < 0.05), gemcitabine (GEM) (P < 0.05), GEM plus cisplatin (DDP) (P < 0.05), and GEM plus 5-fluorouracil (5-FU) (P < 0.05). The adverse effects (mainly including skin damage and fever) in the HIFU plus radiation and chemotherapy group was similar to those in the control group with no significant difference (P > 0.05). Conclusion Current evidence suggests that HIFU plus radiation and chemotherapy for pancreatic cancer is superior to other therapies with less adverse reaction. However, the poor quality of the included studies reduces the reliability of outcome to some extent. Thus, it is necessary to regulate and unify the criteria of diagnosis and outcome measures in the treatment of pancreatic cancer and improve the quality of study design and implementation in clinical studies, so as to provide high quality evidence for its clinical application.

Citation： LICui-cui, WANGYing-qiang, LIYou-ping, LIXiang-lian. Effectiveness and Safety of High-intensity Focused Ultrasound for Pancreatic Cancer: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(11): 1332-1342. doi: 10.7507/1672-2531.20140216 Copy

1.	?Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008:GLOBOCAN 2008. Int J Cancer, 2010, 127(12):2893-2897.
2.	袁耀宗, 何相宜.胰腺癌臨床研究的熱點問題.中華消化雜志, 2011, 31(5):356-357.
3.	趙平.我國胰腺癌診治策略的研究.胰腺病學, 2002, 2(4):193-195.
4.	張宇, 毛偉敏.高強度聚焦超聲及其在胰腺癌中的治療.腫瘤學雜志, 2008, 14(11):951-953.
5.	陳平, 孫燕, 周際昌, 主編.腫瘤內科手冊.第3版.北京:人民衛生出版社, 1996:30-34.
6.	Leslie T, Kennedy J, Illing R, et al. High-intensity focused ultrasound ablation of liver tumors:can radiological assessment predict the histological response? British Journal of Radiology, 2008, 81:564-571.
7.	Burris HA 3rd, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreatic cancer:a randomized trial. J Clin Oncol, 1997, 15(6):2403-2413.
8.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
9.	Balshem H, Helfand M, Schunemann HJ, et al. GRADE guidelines:3. Rating the quality of evidence. J Clin Epidemiol, 2011, 64(4):401-406.
10.	徐成, 胡月珍, 楊華清.高能聚焦超聲聯合三維適形放療治療晚期胰腺癌的臨床觀察.求醫問藥(學術版), 2012, 10(1):200-201.
11.	陳蛟紅, 胡紅超.三維適形放療聯合HIFU刀治療胰腺癌的臨床觀察.中外醫療, 2011, 30(21):44.
12.	陳斌, 陳海燕, 周小祥, 等.中晚期胰腺癌三維適形放療輔助高強度聚焦超聲的臨床觀察.中國腫瘤臨床與康復, 2010, 17(3):251-253.
13.	孫桂麗, 任志紅.高強度聚焦超聲聯合三維適形放療治療晚期胰腺癌的臨床觀察.內蒙古民族大學學報, 2008, 14(2):105-106.
14.	史南, 歐善際, 彭曉暉.高強度聚焦超聲聯合吉西他濱治療胰腺癌療效觀察.中國全科醫學, 2011, 14(14):1597-1598.
15.	王楠婭, 趙恒軍, 鄭曉輝, 等.高強度聚焦超聲聯合吉西他濱治療不可切除胰腺癌的臨床療效.臨床肝膽病雜志, 2011, 27(11):1193-1195.
16.	虞陽, 張宇, 趙洪, 等.高能聚焦超聲熱療對晚期胰腺癌的療效觀察.中華胰腺病雜志, 2009, 9(3):151-155.
17.	曾慶東, 呂麗紅, 張秀國, 等.高強度聚焦超聲聯合健擇治療晚期胰腺癌的臨床研究.中華肝膽外科雜志, 2006, 12(11):748-750.
18.	高宏建, 董戩, 胡墨, 等.高強度聚焦超聲治療晚期胰腺癌的近期療效觀察.中國醫科大學學報, 2010, 39(6):491-493.
19.	卞曉山, 魏長宏, 王作志, 等. HIFU聯合吉西他濱+順鉑治療晚期胰腺癌的療效觀察.中國老年腫瘤學大會暨第三屆CGOS學術年會論文集, 2009:254-258.
20.	陳平, 宋俊彪, 陳蘇蓉, 等.健擇聯合化療合并高能聚焦超聲刀治療晚期胰腺癌療效觀察.中外醫療, 2008, 27(22):55-56.
21.	高遠, 馮軍, 王慶才.高能聚焦超聲"刀"合并gp方案治療晚期胰腺癌的療效觀察.蘇州大學學報·醫學版, 2006, 26(3):428-430.
22.	吳同勝, 譚衛林, 鄭樹范, 等.高能聚焦超聲聯合動脈灌注化療治療晚期胰腺癌32例.腫瘤學雜志, 2009, 15(2):142-144.
23.	毛利峰, 壽曉雯, 李可夫.高能超聲聚焦刀聯合動脈灌注化療治療中晚期胰腺癌的療效觀察.中國實用醫刊, 2009, 36(8):36-37.
24.	王榕生穆劉束.高能聚焦超聲熱療合并化療治療晚期胰腺癌近期療效觀察.南京醫科大學學報(自然科學版), 2003, 23(5):460-463.
25.	張宇, 洪勇強, 黃麗君, 等.高強度聚焦超聲治療進展期胰腺癌46例.中國腫瘤, 2009, 18(1):82-84.
26.	張一平, 趙景志, 喬新榮, 等.動脈灌注化療聯合高強度聚焦超聲治療胰腺癌的臨床研究.介入放射學雜志, 2011, 20(12):964-968.
27.	殷廷哲, 金效民.高強度聚焦超聲聯合腹腔化療治療晚期胰腺癌的療效觀察.實用腫瘤學雜志, 2009, 23(2):146-147.
28.	秦成坤, 崔現平, 張振海. HIFU治療無法手術切除的胰腺癌21例效果觀察.山東醫藥, 2010, 50(51):1-3.
29.	杜春輝, 陸培新, 王連新, 等.三維適形放療聯合高強度聚焦超聲治療中晚期胰腺癌臨床療效.中國實用醫藥, 2012, 7(13):5-6.
30.	趙洪.高強度聚焦超聲(HIFU)聯合吉西他濱治療晚期胰腺癌.第二屆國際腫瘤靶向治療大會暨中法靶向放療論壇論文集, 2008:321-322.
31.	徐周敏, 裴峰, 陳堅, 等.高強度聚焦超聲與伽瑪刀治療晚期胰腺癌的對比觀察.中國腫瘤臨床, 2010, 37(12):689-691.
32.	謝德榮陳岱佳, 滕虹, 等. Hifu聯用雙氟他濱治療晚期胰腺癌的初步臨床研究.嶺南現代臨床外科, 2001, 1(4):226-228.

1. ?Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008:GLOBOCAN 2008. Int J Cancer, 2010, 127(12):2893-2897.
2. 袁耀宗, 何相宜.胰腺癌臨床研究的熱點問題.中華消化雜志, 2011, 31(5):356-357.
3. 趙平.我國胰腺癌診治策略的研究.胰腺病學, 2002, 2(4):193-195.
4. 張宇, 毛偉敏.高強度聚焦超聲及其在胰腺癌中的治療.腫瘤學雜志, 2008, 14(11):951-953.
5. 陳平, 孫燕, 周際昌, 主編.腫瘤內科手冊.第3版.北京:人民衛生出版社, 1996:30-34.
6. Leslie T, Kennedy J, Illing R, et al. High-intensity focused ultrasound ablation of liver tumors:can radiological assessment predict the histological response? British Journal of Radiology, 2008, 81:564-571.
7. Burris HA 3rd, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreatic cancer:a randomized trial. J Clin Oncol, 1997, 15(6):2403-2413.
8. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
9. Balshem H, Helfand M, Schunemann HJ, et al. GRADE guidelines:3. Rating the quality of evidence. J Clin Epidemiol, 2011, 64(4):401-406.
10. 徐成, 胡月珍, 楊華清.高能聚焦超聲聯合三維適形放療治療晚期胰腺癌的臨床觀察.求醫問藥(學術版), 2012, 10(1):200-201.
11. 陳蛟紅, 胡紅超.三維適形放療聯合HIFU刀治療胰腺癌的臨床觀察.中外醫療, 2011, 30(21):44.
12. 陳斌, 陳海燕, 周小祥, 等.中晚期胰腺癌三維適形放療輔助高強度聚焦超聲的臨床觀察.中國腫瘤臨床與康復, 2010, 17(3):251-253.
13. 孫桂麗, 任志紅.高強度聚焦超聲聯合三維適形放療治療晚期胰腺癌的臨床觀察.內蒙古民族大學學報, 2008, 14(2):105-106.
14. 史南, 歐善際, 彭曉暉.高強度聚焦超聲聯合吉西他濱治療胰腺癌療效觀察.中國全科醫學, 2011, 14(14):1597-1598.
15. 王楠婭, 趙恒軍, 鄭曉輝, 等.高強度聚焦超聲聯合吉西他濱治療不可切除胰腺癌的臨床療效.臨床肝膽病雜志, 2011, 27(11):1193-1195.
16. 虞陽, 張宇, 趙洪, 等.高能聚焦超聲熱療對晚期胰腺癌的療效觀察.中華胰腺病雜志, 2009, 9(3):151-155.
17. 曾慶東, 呂麗紅, 張秀國, 等.高強度聚焦超聲聯合健擇治療晚期胰腺癌的臨床研究.中華肝膽外科雜志, 2006, 12(11):748-750.
18. 高宏建, 董戩, 胡墨, 等.高強度聚焦超聲治療晚期胰腺癌的近期療效觀察.中國醫科大學學報, 2010, 39(6):491-493.
19. 卞曉山, 魏長宏, 王作志, 等. HIFU聯合吉西他濱+順鉑治療晚期胰腺癌的療效觀察.中國老年腫瘤學大會暨第三屆CGOS學術年會論文集, 2009:254-258.
20. 陳平, 宋俊彪, 陳蘇蓉, 等.健擇聯合化療合并高能聚焦超聲刀治療晚期胰腺癌療效觀察.中外醫療, 2008, 27(22):55-56.
21. 高遠, 馮軍, 王慶才.高能聚焦超聲"刀"合并gp方案治療晚期胰腺癌的療效觀察.蘇州大學學報·醫學版, 2006, 26(3):428-430.
22. 吳同勝, 譚衛林, 鄭樹范, 等.高能聚焦超聲聯合動脈灌注化療治療晚期胰腺癌32例.腫瘤學雜志, 2009, 15(2):142-144.
23. 毛利峰, 壽曉雯, 李可夫.高能超聲聚焦刀聯合動脈灌注化療治療中晚期胰腺癌的療效觀察.中國實用醫刊, 2009, 36(8):36-37.
24. 王榕生穆劉束.高能聚焦超聲熱療合并化療治療晚期胰腺癌近期療效觀察.南京醫科大學學報(自然科學版), 2003, 23(5):460-463.
25. 張宇, 洪勇強, 黃麗君, 等.高強度聚焦超聲治療進展期胰腺癌46例.中國腫瘤, 2009, 18(1):82-84.
26. 張一平, 趙景志, 喬新榮, 等.動脈灌注化療聯合高強度聚焦超聲治療胰腺癌的臨床研究.介入放射學雜志, 2011, 20(12):964-968.
27. 殷廷哲, 金效民.高強度聚焦超聲聯合腹腔化療治療晚期胰腺癌的療效觀察.實用腫瘤學雜志, 2009, 23(2):146-147.
28. 秦成坤, 崔現平, 張振海. HIFU治療無法手術切除的胰腺癌21例效果觀察.山東醫藥, 2010, 50(51):1-3.
29. 杜春輝, 陸培新, 王連新, 等.三維適形放療聯合高強度聚焦超聲治療中晚期胰腺癌臨床療效.中國實用醫藥, 2012, 7(13):5-6.
30. 趙洪.高強度聚焦超聲(HIFU)聯合吉西他濱治療晚期胰腺癌.第二屆國際腫瘤靶向治療大會暨中法靶向放療論壇論文集, 2008:321-322.
31. 徐周敏, 裴峰, 陳堅, 等.高強度聚焦超聲與伽瑪刀治療晚期胰腺癌的對比觀察.中國腫瘤臨床, 2010, 37(12):689-691.
32. 謝德榮陳岱佳, 滕虹, 等. Hifu聯用雙氟他濱治療晚期胰腺癌的初步臨床研究.嶺南現代臨床外科, 2001, 1(4):226-228.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of High-intensity Focused Ultrasound for Pancreatic Cancer: A Systematic Review

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