ObjectiveTo evaluate the clinical efficacy, safety, and survival outcomes of CT-guided iodine-125 seed implantation in patients with stage Ⅲ–Ⅳ pancreatic cancer, and to analyze the relevant factors influencing prognosis. MethodsClinical data of patients with stage Ⅲ–Ⅳ pancreatic cancer who underwent CT-guided iodine-125 seed implantation and had complete follow-up records at the First Affiliated Hospital of Army Medical University from June 2013 to February 2023 were retrospectively collected. Post-treatment efficacy, the Karnofsky performance status (KPS) score and numeric rating scale (NRS) score for pain at one month post-procedure, and postoperative complications were analyzed. The overall survival (OS) was also analyzed. Univariate and multivariate Cox proportional hazards regression models were employed to identify risk factors influencing OS. ResultsA total of 44 eligible patients with stage Ⅲ–Ⅳ pancreatic cancer were included in this study. According to the response evaluation criteria in solid tumors 1.1 criteria, the objective response rate was 61.4% (27/44) and the disease control rate was 95.5% (42/44). At one month postoperatively, the KPS score significantly improved from a preoperative value of (78.18±5.40) points to (86.82±5.18) points (P<0.001); the pain NRS score significantly decreased from a preoperative median [interquartile range (IQR)] of 4 (3, 5) to 1 (0, 2.5), P<0.001. The preoperative planned target volume D90 was 120 (116, 125) Gy, and the postoperative delivered D90 was 124 (119, 127) Gy (P=0.060). The median overall survival (OS) was 17.0 months for stage Ⅲ patients and 12.0 months for stage Ⅳ patients (P=0.05). Multivariate analysis revealed that clinical stage [Stage Ⅳ vs. Ⅲ: HR (95%CI)=2.29 (1.16, 4.50), P=0.016] and gross tumor volume [HR (95%CI)=1.01 (1.00, 1.02), P=0.012] were independent prognostic factors affecting OS. ConclusionsBased on the retrospective analysis results of this study, CT-guided iodine-125 seed implantation, as a local treatment modality for stage Ⅲ–Ⅳ pancreatic cancer, can effectively achieve local tumor control, alleviate pain, improve quality of life, and prolong survival of patients, with particularly significant benefits observed in stage Ⅲ patients, and demonstrates a favorable safety profile. Clinical stage Ⅳ and increased gross tumor volume are identified as independent factors affecting OS. This technique provides a treatment option for patients with inoperable stage Ⅲ–Ⅳ pancreatic cancer.
【Abstract】 Objective The effects and the complications of anhydrous alcohol intra-abdominal coeliac plexus block were studied for treating unresectable pancreatic cancer pain. Methods From Jan.2001 to Sep.2005, 61 patients with severe pancreatic cancer pain and accompanied gastrointestinal tract obstruction were treated by anhydrous alcohol intra-abdominal coeliac plexus block and palliative surgical therapy. Pain-relief, KPS and complications in 3 months after operation were observed. Results The cancer pain in all patients was controlled in one week after the block (P＜0.05). KPS was improved (P＜0.05). Three months after operation, 45(86.5%) patients were without pain or with only light pain. There were no severe complications. Conclusion Anhydrous alcohol intra-abdominal coeliac plexus block is a method with safe and good effective and less complications for the treatment of pancreatic carcinomatous pain.
Objective
To evaluate the efficacy and safety of capecitabine combination chemotherapy for advanced pancreatic cancer.
Methods
The Cochrane Library, PubMed, EMbase, CBM, CNKI and WanFang Data databases were searched to collect randomized controlled trials (RCTs) on capecitabine combination chemotherapy for advanced pancreatic cancer from inception to December, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, data were analyzed by using RevMan 5.3 software.
Results
Six RCTs were included. The results of meta-analysis showed that compared with the control group, capecitabine combination chemotherapy extended the overall survival (HR=0.86, 95%CI 0.77 to 0.96, P=0.006) and disease progression-free survival (HR=0.83, 95%CI 0.75 to 0.91, P=0.000 2). Moreover, the objective response rate was significantly increased in capecitabine combination chemotherapy (RR=1.64, 95%CI 1.27 to 2.11, P=0.000 1). The results of 3–4 toxic side effects of 6 RCTs indicated that the incidence of neutropenia, stomatitis and hand-foot syndrome of capecitabine combination chemotherapy were obviously higher than those in the control group (P<0.05).
Conclusions
Capecitabine combination chemotherapy extend the overall survival and disease progression-free survival, and improve the objective response rate. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
ObjectivesTo evaluate the economic efficacy of nab-paclitaxel (NAB-P) combined with gemcitabine (GEM) versus GEM alone in the treatment of metastatic pancreatic cancer in China.MethodsA Markov model simulating the costs and health outcomes was developed to estimate quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). The impact of parameter uncertainty on the model was assessed by deterministic one-way sensitivity analysis.ResultsNAB-P combined with GEM was shown superior efficacy compared to gemcitabine monotherapy, however with higher costs. The ICER between the two groups was 964 780.79￥/QALY.ConclusionsCompared with gemcitabine monotherapy, NAB-P combined with GEM is not cost-effective. The conclusion is confirmed by deterministic one-way sensitivity analysis.
