Endoscopic Ultrasound guided Celiac Ganglion Irradiation with Iodine-125 Seeds in Patients with Unresectable Pancreatic Cancer:Results of a Pilot Trial

Aims: Celiac plexus neurolysis and block are considered safe but provide limited pain relief. The recent recognition that celiac ganglia can be visualized by endoscopic ultrasound (EUS) now allows direct injection into celiac ganglia for neurolysis (CGN). Radioactive rays have a definite injurious effect on neural tissues.

Aim: To determine the safety, immediate and long-term efficacy of ganglion irradiation with Iodine-125 seeds in patients with moderate to severe pain secondary to unresectable pancreatic carcinoma.

Methods: Thirty patients were divided into two groups: 15 patients had 0.7 mCi 125I seeds implanted (group 1) and 15 were treated with pharmacological therapy (group 2). Immediate and long-term efficacy, mean analgesic consumption, mortality and morbidity were evaluated at follow-up. Statistical analysis was performed with the unpaired t test, Mann-Whitney U test and Fisher's exact test.

Results: A mean number of four radioactive seeds per patient were implanted into the celiac ganglion. Immediately after the precedure, pain relief and analgesic consumption did not differ between two groups. Inversely, four patients reported pain exacerbation. But 14 days latter, patients in group 1 reported significant pain relief compared with those in group 2 (P<0.05). Mean analgesic consumption was lower in group 1 (P<0.05). There were no deaths. No complications such as transient diarrhoea, hypotension or infection occured..

Conclusion: Celiac ganglion irradiation was associated with a reduction in analgesic drug administration and drug-related adverse effects, representing an new effective tool in the treatment of pancreatic cancer pain.