title: Pilot trial of endoscopic ultrasound-guided interstitial chemoradiation of UICC-T4 pancreatic cancer.
abstract: OBJECTIVE
  Both interstitial brachytherapy and interstitial chemotherapy are effective in improving local control in patients with local UICC-T4 pancreatic cancer. In this study, we report the results of endoscopic ultrasound (EUS)-guided interstitial chemoradiation (EUS-ICR) in patients with advanced pancreatic cancer, with respect to tumor response, clinical response, safety, and complications.
  
  
  METHODS
  A total of 8 patients (3 men, 5 women; median age of 69) with T4 pancreatic adenocarcinoma were the subjects of this study. A mean of 18 radioactive seeds and 36 intratumoral implants for sustained delivery of 5-fluorouracil in each patient were implanted into the tumors using EUS-guided needle puncture. The mean total implanted radioactive activity was 13.68 mCi, the mean total dose of intratumoral 5-fluorouracil was 3.6 g, and the mean volume of implants was 28 cm(3). The conditions of the patients were followed-up by examination and imaging tests every two months. Clinical endpoints included the Karnofsky performance status, pain response, tumor response (assessed by computed tomography and/or EUS), and survival.
  
  
  RESULTS
  During a median follow-up period of 8.3 months, the objective tumor response was classified as "partial" in 1 of 8 patients (with a median duration of partial response of 3 months), "minimal" in 2 patients, and indicative of "stable disease", in 3 of 8 patients. Clinical benefit was shown in 4 of 8 patients, which was mostly due to pain reduction, and lasted for 3.5 months. No local complications or hematologic toxicity occurred.
  
  
  CONCLUSIONS
  EUS-ICR had a moderate local anti-tumor effect, showed some clinical benefits in 4 of the 8 patients, and was well tolerated by all the patients in this study.
authors.affiliation: Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Siyu
authors.initials: S
authors.lastname: Sun
authors.affiliation: Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Ge
authors.affiliation: Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Wang
authors.affiliation: Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Liu
authors.affiliation: Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Guoxin
authors.initials: G
authors.lastname: Wang
authors.affiliation: Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Jintao
authors.initials: J
authors.lastname: Guo
keywords: endoscopic ultrasound; interstitial therapy; pancreatic cancer