Ultraschall Med 2019; 40(05): 625-637
DOI: 10.1055/a-0591-3386
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Clinical Effectiveness and Potential Survival Benefit of US-Guided High-Intensity Focused Ultrasound Therapy in Patients with Advanced-Stage Pancreatic Cancer

Klinische Wirksamkeit und potenzielle Überlebensvorteile der Therapie mit US-gesteuertem hoch-intensivem fokussiertem Ultraschall bei Patienten mit fortgeschrittenem Pankreaskarzinom
Milka Marinova*
1   Department of Radiology, Medical School and University Clinics Bonn, Germany
,
Hannah C. Huxold*
1   Department of Radiology, Medical School and University Clinics Bonn, Germany
,
Jana Henseler
1   Department of Radiology, Medical School and University Clinics Bonn, Germany
,
Martin Mücke
2   Department of Palliative Medicine, Department of General Practice and Family Medicine, Medical School and University Clinics Bonn, Germany
,
Rupert Conrad
3   Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, Medical School and University Clinics Bonn, Germany
,
Roman Rolke
4   Department of Palliative Medicine, Medical School and University Clinics Aachen, Germany
,
Hojjat Ahmadzadehfar
5   Department of Nuclear Medicine, Medical School and University Clinics Bonn, Germany
,
Maximilian Rauch
1   Department of Radiology, Medical School and University Clinics Bonn, Germany
,
Rolf Fimmers
6   Institute of Medical biometry, Informatics and Epidemiology, Medical School and University Clinics Bonn, Germany
,
Guido Luechters
7   Center of Development Research, University of Bonn, Germany
,
Henning Cuhls
8   Department of Palliative Medicine, Medical School and University Clinics Bonn, Germany
,
Lukas Radbruch
8   Department of Palliative Medicine, Medical School and University Clinics Bonn, Germany
,
Hans H. Schild
1   Department of Radiology, Medical School and University Clinics Bonn, Germany
,
Holger Strunk
1   Department of Radiology, Medical School and University Clinics Bonn, Germany
› Author Affiliations
Further Information

Publication History

11 September 2017

23 February 2018

Publication Date:
17 April 2018 (online)

Abstract

Purpose Pancreatic cancer (PaC) is a life-limiting tumor with a wide range of incapacitating symptoms such as cancer pain in more than 80 % of patients. This prospective interventional study addresses the clinical effectiveness of ultrasound-guided high-intensity focused ultrasound (HIFU) treatment for patients with advanced-stage PaC, including pain perception, tumor size and survival benefit.

Materials and Methods 50 patients with late-stage PaC underwent HIFU. Clinical assessment included evaluation of tumor volume by imaging and pain burden (pain severity, pain sensation, interference with daily activities) using the Brief Pain Inventory at baseline and follow-up. Median overall survival, progression-free survival and time to local progression were estimated using Kaplan-Meier analysis.

Results In 84 % of patients, significant early relief of cancer-induced abdominal pain was achieved by HIFU independent of metastatic status; it persisted during follow-up. Tumor volume reduction was 37.8 ± 18.1 % after 6 weeks and 57.9 ± 25.9 % after 6 months. 21 % of HIFU-treated patients had local tumor progression with a median time of 14.4 months from intervention. The median overall survival and progression-free survival were 16.2 and 16.9 months from diagnosis and 8.3 and 6.8 months from intervention.

Conclusion In patients with advanced pancreatic cancer and otherwise limited treatment options, HIFU resulted in significant early and long-lasting pain relief and tumor size reduction over time independent of metastatic status. Clinical data suggest an additional potential survival benefit.

Zusammenfassung

Ziel Das Pankreaskarzinom ist ein lebenslimitierender Tumor mit einer Vielzahl von tumorbedingen Beschwerden wie Tumorschmerzen bei mehr als 80 % der Patienten. Ziel dieser prospektiven Studie ist, die klinische Wirksamkeit des Ultraschall-gesteuerten hoch-intensiven fokussierten Ultraschalls (HIFU) in Bezug auf die Schmerintensität und -empfindung, die Tumorgröße und das Überleben zu evaluieren.

Material und Methode Fünfzig Patienten mit fortgeschrittenem Pankreaskarzinom wurden mit HIFU behandelt. Die klinische Evaluation umfasste die Beurteilung des Tumorvolumens durch bildgebende Verfahren sowie der Schmerzbelastung (Schmerzintensität, Schmerzempfindung, Beeinträchtigung der täglichen Aktivitäten) anhand des Brief-pain-inventory-Fragebogens initial und im Verlauf. Das mediane Gesamtüberleben, das progressionsfreie Überleben und die Zeit bis zum lokalen Progress wurden mit der Kaplan-Meier-Analyse evaluiert.

Ergebnisse Nach HIFU wurde bei 84 % der Patienten eine signifikante frühzeitige Reduktion von tumorinduzierten Bauchschmerzen unabhängig vom Metastasierungsstatus erreicht; dieser Effekt blieb im Verlauf erhalten. Die Tumorvolumenreduktion betrug 37,8 ± 18,1 % nach 6 Wochen und 57,9 ± 25,9 % nach 6 Monaten. 21 % der HIFU-behandelten Patienten hatten einen lokalen Tumorprogress mit einer medianen Zeit von 14,4 Monaten nach Intervention. Das mittlere Gesamtüberleben und das progressionsfreie Überleben waren jeweils 16,2 und 16,9 Monate ab Erstdiagnose und 8,3 und 6,8 Monate ab HIFU-Intervention.

Schlussfolgerung Bei Patienten mit fortgeschrittenem Pankreaskarzinom führte HIFU zu einer signifikanten und anhaltenden Schmerzlinderung und Tumorvolumenreduktion im zeitlichen Verlauf unabhängig vom Metastasierungsstatus. Die Auswertung der Überlebensdaten gibt zusätzlich Hinweise auf einen potenziellen Vorteil.

* contributed equally to this manuscript and share first co-authorship


 
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