Lizhi Niu, M.D., Kecheng Xu, M.D.*, Weibing He, M.D., Yisong He, M.D., Jiansheng Zuo, M.D.
Cryosurgery Center for Cancer, Fuda Cancer Hospital Guangzhou, Guangzhou 510300, China

*Corresponding Author: Kecheng Xu, M.D., Email: xukc@vip.163.com

Introduction Cryosurgery provides a new therapeutic approach and has been used for the treatment of many benign and malignant tumors, especially for unresectable tumors. Publications have reported on trials using the modality in the treatment of liver cancer, prostate cancer kidney tumors, breast cancer, and showed encouraging results .There were few of reports about cryosurgery for treatment of pancreatic cancer. We have used combination of cryosurgery and 125iodine seed implantation for the treatment of locally advanced pancreatic cancer, better results have been achieved, the report is as follows.

Technique 38 patients with locally advanced pancreatic cancer, male 28 cases and female 10 cases, with the median age of 57 years old, were enrolled in this study. The diagnosis of disease was based on imaging such as ultrasound, CT and MRI. The disease of 31 cases was confirmed by pathology. Ten cases had metastases of peripancreatic lymph node and 8 cases had liver metastases. The tumors of all cases were considered to be unresectable through a comprehensive evaluation. The therapy included cryosurgery, which was performed intraoperatively or percutaneously under guidance of ultrasound and/or CT, and 125iodine seed (Syncor Pharmaceutica, China) implantation, which was performed during cryosurgery process or post-cryosurgery under guidance of ultrasound and/or CT. There were a few patients who received regional celiac artery chemotherapy.

Results 11 patients received intraoperative cryosurgery and 27 patients received percutaneous cryosurgery. Fourteen patients underwent the second cryosurgery and 3 underwent the third cryosurgery. 125Iodine seed implantation was performed during freezing procedure in 29 cases and with 3-7 days after cryosurgery in 9 cases. Fifteen patients in which 13 had metastases of peripancreatic lymph nodes or liver received regional chemotherapy. At the 3 months after therapy, CT follow-up was performed to estimate the tumor response to therapy. Most of the cases had tumor necrosis of different degree, and complete response (CR) of tumor was seen in 23.6% of patients, partial response (PR) in 42.1%, stable disease (SD) in 26.3%, and progressive disease (PD) in 7.9% (Figure1). The adverse effects associated with cryosurgery mainly included pain of upper abdomen and increased serum amylase activity. Acute pancreatitis was seen in 5 patients in whom one presented hemorrhagic type of pancreatitis. All adverse effects were controlled by medical management with no poor outcome. There was no therapy-related mortality. During the followed-up of median 16 months (range of 5-37) median overall survival was 12 months and there were 20 cases (52.6%) whose survival was 12 months or more. Overall 6, 12, 24 and 36 months survival rates were 94.7%, 49.4%, 21.8% and 5.4% respectively (Figure 2). There were 4 cases that had survival of 24 months or more. The patient with the longest survival is surviving without evidence of recurrence for 37 months.

Conclusion The cryosurgery, due to far less invasive than conventional pancreas resection, and the low rate of adverse effects, should be choice modality for most of the patients with locally advanced pancreatic cancer. 125Iodine seed implantation can destroy the residue survival cancer cells after cryosurgery. Hence, combination of both modalities has a complementary effect.

Key words: Pancreatic cancer, Cryosurgery, 125Iodine seed implantation.

Legends of Figures

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Figure 1: CT scan of a case. (A) Before treatment, a mass was seen in pancreatic body and trail. (B) One month after treatment. (C) 6 months after treatment