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Ultraschall Med 2018; 39(06): 650-658
DOI: 10.1055/s-0043-125391
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Mesenteric Vessel Patency Following HIFU Therapy in Patients with Locally Invasive Pancreatic Cancer

Auswirkungen der US-gesteuerten HIFU-Ablation auf die großen Oberbauchgefäße beim lokal infiltrierenden Pankreaskarzinom.
Holger M. Strunk
1   Department of Radiology, University Hospital, Bonn, Germany
,
Caroline Lützow
1   Department of Radiology, University Hospital, Bonn, Germany
,
Jana Henseler
1   Department of Radiology, University Hospital, Bonn, Germany
,
Martin Mücke
2   Department of Palliative Medicine, University Hospital, Bonn, Germany
3   Department of General Practice and Family Medicine, University Hospital, Bonn, Germany
,
Maximilian Rauch
1   Department of Radiology, University Hospital, Bonn, Germany
,
Christian Marx
1   Department of Radiology, University Hospital, Bonn, Germany
,
Hans H. Schild
1   Department of Radiology, University Hospital, Bonn, Germany
,
Milka Marinova
1   Department of Radiology, University Hospital, Bonn, Germany
› Author Affiliations
Further Information

Publication History

31 May 2017

05 December 2017

Publication Date:
18 January 2018 (online)

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Abstract

Purpose To evaluate the effects of HIFU therapy on visceral vessel patency in patients with inoperable locally invasive pancreatic cancer.

Materials and Methods 50 pancreatic cancer patients (26 men, 24 women) aged 41 – 82 years (65.0 ± 10.2) underwent ultrasonography (US) and computed tomography (CT) examinations before and within one day after HIFU treatment, as well as at follow-up at six weeks, three months and six months. Evaluation and grading were performed by two experienced independent radiologists according to a classification scheme based on vessel involvement, vessel diameter, patency, and defects in flow.

Results Before HIFU treatment, arterial vessel involvement was noted in 42 patients, venous involvement in 47, and 47 patients presented with both. Superior mesenteric artery occlusion was found in three carcinomas while nearly half of the cases (n = 24) displayed signs of superior mesenteric vein, portal vein, or splenic vein occlusion. High-grade tumor-associated arterial narrowing was seen in ten patients. Despite vessel encasement and partially extensive propagation of collateral vessels, it was possible to safely perform HIFU treatment in all patients without complications. US and CT studies performed within one day after therapy did not show any change in vessel patency in 47 patients (94 %). Follow-up controls at the six-week mark revealed increased vessel narrowing and finally occlusion after six months in 11 patients due to tumor progression.

Conclusion This study demonstrates that HIFU treatment can be safely applied to pancreatic cancers enveloping large mesenteric vessels despite vessel narrowing or extensive collateral propagation. Most patients (94 %) did not experience adverse effects regarding vessel patency.

Zusammenfassung

Ziel Analyse der Auswirkungen der US-gesteuerten HIFU-Therapie auf die großen Oberbauchgefäße bei Patienten mit inoperablem Pankreaskarzinom.

Material und Methode Beurteilung der sonografischen und computertomografischen Untersuchungen von 50 konsekutiv mit HIFU behandelten Patienten (26 Männer und 24 Frauen) zwischen 41 und 82 (65,0 ± 10,2) Jahren vor und unmittelbar nach der HIFU-Therapie sowie nach 6 Wochen, 3 und 6 Monaten. Die Auswertung erfolgte durch zwei unabhängige Untersucher aufgeschlüsselt nach Gefäßen und Grad der Gefäßbeteiligung (0 = keine Gefäßbeteiligung, 1 = Tumor reicht an das Gefäß heran, keine Einengung, 2 = mäßige Gefäßeinengung, 3 = filiforme Gefäßeinengung, 4 = Gefäßverschluss).

Ergebnisse Vor HIFU-Therapie lag bei 42 der Patienten eine Beteiligung der arteriellen, bei 47 Patienten der venösen Gefäße und 47 Patienten von beiden vor. Dabei wiesen 10 Patienten eine tumorbedingte filiforme arterielle Gefäßeinengung, drei einen Verschluss der A. mesenterica sup., nahezu die Hälfte (n = 24) einen Verschluss von V. mesenterica sup., Pfortader oder Milzvene auf. Trotz dieser Gefäßummauerung und der zum Teil massiv erkennbaren Kollateralgefäße konnte eine HIFU-Therapie bei allen Patienten klinisch komplikationslos durchgeführt werden. Die Kontrollen unmittelbar nach durchgeführter HIFU-Behandlung zeigten bei 47 der Patienten (94 %) keine Änderung des Gefäßstatus. Durch Tumorprogress kam es bei 11 Patienten zu einer zunehmenden Gefäßeinengung ab der sechsten Woche bis hin zum Verschluss nach 6 Monaten.

Schlussfolgerung Eine HIFU-Ablation beim lokal fortgeschrittenen Pankreaskarzinom ist auch bei mesenterialer Gefäßbeteiligung und ausgeprägten Umgehungskreisläufen sicher möglich. Bei den meisten Patienten (94 %) hat die Therapie trotz z. T. hochgradiger Stenosen keine nachteilige Auswirkung auf die Gefäßsituation.

Key words

Ultrasound-High Intensity Focused (HIFU) - pancreas - neoplasms-primary - ablation - vessel patency
 

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