CT-Guided Percutaneous Radioactive I Brachytherapy for Locally Advanced Pancreatic Cancer.

[PURPOSE] To explore the efficacy and safety of I source implantation via a coaxial puncture in treating locally advanced pancreatic cancer (LAPC).

[METHODS] A retrospective analysis was used to investigate the efficacy and safety of 40 patients with LAPC treated with radioactive I particles under CT guidance in the hospital. A treatment planning system was used to develop the preoperative plan, and the radioactive I particles were implanted using a coaxial puncture technique in the same plane to simulate a sector distribution system. CT scans were performed at postoperative months 2, 4, and 6 for follow-up treatment outcome assessment. Overall survival (OS) time and progression-free survival (PFS) were calculated, and factors affecting prognosis were assessed.

[RESULTS] All patients completed the operation successfully. The overall response rate of treatment at 2, 4, and 6 months was 37.5%, 47.5%, and 50.0%. The median OS and PFS were 11.0 months (95% confidence interval [CI]: 9.14-12.86) and 9.0 months (95% CI: 7.45-10.55), respectively. The 6- and 12-month PFS rates were 85.0% (95% CI: 69.6%-93.0%) and 35.0% (95% CI: 20.8%-49.5%), respectively. The 12-month OS rates were 47.5% (95% CI: 20.2%-49.8%). The intraoperative complications related to the operation were local abdominal hemorrhage in 2 cases, subcutaneous soft tissue hematoma in 2 cases, and wrong puncture of the pancreatic duct in 1 case. The main side-effects were fever in 10 cases and decreased appetite in 3 cases in the recent postoperative period. Eighteen grade 0 cases and 3 cases of grade I acute radiation enteritis occurred. No acute radiation damage above grade II and late radiation damage was observed.

[CONCLUSIONS] Coaxial puncture I source implantation is a promising percutaneous minimally invasive technology that is safe and effective in treating LAPC.