title: The investigation of 125I seed implantation as a salvage modality for unresectable pancreatic carcinoma.
abstract: BACKGROUND
  To assess the efficacy of intraoperative ultrasound-guided implantation of 125I seeds for the treatment of unresectable pancreatic carcinoma, and analyze the associated prognostic factors.
  
  
  METHODS
  Twenty-eight patients with pancreatic carcinoma who underwent laparotomy and were considered to have unresectable tumors were included in this study. Nine patients were pathologically diagnosed with Stage II disease, and nineteen patients with Stage III disease. Twenty-eight patients received intraoperative ultrasound-guided 125I seed implantation and received a D90 (at least 90% of the tumor volume received the reference dose) ranging from 60 to 163 Gy, with a median of 120 Gy. Seven patients received an additional 35-50 Gy external beam radiotherapy after seed implantation, and ten patients received two to ten cycles of chemotherapy. Overall survival of the patients was calculated and prognostic factors were evaluated.
  
  
  RESULTS
  Of the patients, 94.1% (16/17) achieved good to medium pain relief. The tumor response rate was 78.6% (22/28), and local control was achieved in 85.7% (24/28) of patients. The 1-, 2- and 3-year survival rates were 30%, 11% and 4%, and the median survival was 10.1 months (95% CI: 9.0-10.9). Analysis using the Cox proportional hazards model suggested that patients younger than 60 years and patients who received a D90 higher than 110 Gy may survive for a longer period.
  
  
  CONCLUSIONS
  I seed implantation provides a safe and effective method to relieve pain, control local tumor growth and, to some extent, prolong the survival of patients with stage II and III pancreatic disease, without additional complications. Age and accumulated dose may be factors predictive of a favorable outcome for patients with unresectable pancreatic carcinoma treated with 125I seeds. These findings need to be validated by conducting further studies with larger cohorts.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Peking University 3rd Hospital, Huan-yuan North Road 49th, Beijing 100083, P, R, China. junjiewang_edu@sina.cn.
authors.forename: Junjie
authors.initials: J
authors.lastname: Wang
authors.forename: Yuliang
authors.initials: Y
authors.lastname: Jiang
authors.forename: Jinna
authors.initials: J
authors.lastname: Li
authors.forename: Suqing
authors.initials: S
authors.lastname: Tian
authors.forename: Weiqiang
authors.initials: W
authors.lastname: Ran
authors.forename: Dianrong
authors.initials: D
authors.lastname: Xiu
authors.forename: Yang
authors.initials: Y
authors.lastname: Gao
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010146:Pain / Q000532:radiotherapy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D016879:Salvage Therapy / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D007457:Iodine Radioisotopes