title: A retrospective analysis of survival factors of high intensity focused ultrasound (HIFU) treatment for unresectable pancreatic cancer.
abstract: To retrospectively evaluate possible impact factors of HIFU treatment outcome for unresectable pancreatic cancer patients.
  
  
  
  A total of 689 patients with unresectable pancreatic cancer were recruited in our center from December 30, 2007 to January 30, 2015. 436 patients with unresectable pancreatic cancers received HIFU treatment; the other 253 patients received non-HIFU treatment. Among these 436 patients, 345 patients received a one-time HIFU treatment, 91 patients received HIFU treatment from 2 to 5 times in the same pancreatic mass; 89 patients received HIFU treatment alone; 347 patients received HIFU-based combined therapies. Complications and overall survivals (OS) data in each group were collected.
  
  
  
  The median overall survivals (mOS) in HIFU group and non-HIFU group were 7.1 vs. 5 months (P=0.005): 9.3 vs. 7.3 months (P=0.202) for patients with stage II disease, 8.3 vs. 7.3 months (P=0.783) for patients with stage III disease, and 6.4 vs. 4.2 months (P<0.0001) for patients with stage IV disease, respectively. Furthermore, there was a significant difference between repeated HIFU and one-time HIFU (mOS: 8.6 vs. 6.8 months, P=0.011). Time of HIFU treatment (P=0.0027), chemotherapy (P<0.0001), radiotherapy (P=0.0006), regional intra-arterial chemotherapy (RIAC) (P<0.0001), and stage (P<0.0001) were independent prognostic factors for the patients who received HIFU treatment. Cox analysis on the relative risk of prognostic factors showed that repeated HIFU vs. one-time HIFU (HR=0.729: 95% CI=0.576-0.924), chemotherapy vs. non-chemotherapy (HR=0.664: 95% CI=0.576-0.766), radiotherapy vs. non-radiotherapy (HR=0.580: 95% CI=0.427-0.789), RIAC vs. non-RIAC (HR=0.737: 95% CI=0.648-0.837), and stage (HR=1.386, 95% CI=1.187-1.619) were associated with significantly inferior survival. Overall, adverse events occurred in 23.2% (101/436) in the HIFU group, which included increase of serum or urinary amylase levels, incomplete intestinal obstruction, mild fever, etc. There were no severe adverse events such as skin burns or GI perforation related to HIFU therapy in any of the patients treated.
  
  
  
  This retrospective analysis revealed that the use of a multimodal treatment approach (the combined therapy of HIFU, RIAC, and chemotherapy, with or without radiotherapy) could improve survival of patients with unresectable pancreatic cancer, and repeated HIFU presented a survival benefit and did not increase risk.
authors.affiliation: Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.|These authors contributed equally to this work.
authors.forename: Zhou-Yu
authors.initials: ZY
authors.lastname: Ning
authors.affiliation: Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.|These authors contributed equally to this work.
authors.forename: Chien-Shan
authors.initials: CS
authors.lastname: Cheng
authors.affiliation: Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.|These authors contributed equally to this work.
authors.forename: Jing
authors.initials: J
authors.lastname: Xie
authors.affiliation: Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.|These authors contributed equally to this work.
authors.forename: Qi-Wen
authors.initials: QW
authors.lastname: Chen
authors.affiliation: Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.|These authors contributed equally to this work.
authors.forename: Li-Tao
authors.initials: LT
authors.lastname: Xu
authors.affiliation: Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Zhuang
authors.affiliation: Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Chen-Yue
authors.initials: CY
authors.lastname: Zhang
authors.affiliation: Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Li-Bin
authors.initials: LB
authors.lastname: Song
authors.affiliation: Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Shi
authors.affiliation: Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Zhu
authors.affiliation: Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Wang
authors.affiliation: Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Meng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood / Q000652:urine; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use; D057086:High-Intensity Focused Ultrasound Ablation / Q000009:adverse effects*; D006801:Humans; D007269:Injections, Intra-Arterial; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000628:therapy*; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology* / Q000652:urine; D012189:Retrospective Studies; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000681:Amylases; D005472:Fluorouracil; D000093542:Gemcitabine