Download PDF
Endoscopy 2002; 34(7): 555-559
DOI: 10.1055/s-2002-33214
Original Article
© Georg Thieme Verlag Stuttgart · New York

Treatment of Unresectable Pancreatic Carcinoma by Intraluminal Brachytherapy in the Duct of Wirsung

M.  Mutignani 1 , S.  K.  Shah 1 , A.  G.  Morganti 2 , V.  Perri 1 , G.  Macchia 2 , G.  Costamagna 1
  • 1Digestive Endoscopy Unit , Università Cattolica del Sacro Cuore, Rome, Italy
  • 2Department of Radiotherapy, Università Cattolica del Sacro Cuore, Rome, Italy
Further Information

Publication History

Submitted 30 August 2001

Accepted after Revision 19 February 2002

Publication Date:
12 August 2002 (online)

Also available at
    Permissions and Reprints

Background and Study Aims: Our aim was to evaluate the feasibility and clinical outcome of intraluminal brachytherapy (ILBT) in the duct of Wirsung in patients with unresectable pancreatic adenocarcinoma.
Patients and Methods: Nine patients (eight men, one woman; mean age 72.4 ± 9.1, range 52 - 80) with unresectable pancreatic adenocarcinoma of the head or body underwent ERCP for biliary and/or pancreatic stent placement and placement of a nasopancreatic drain with/without nasobiliary drain. The ILBT dose administered was 30 - 50 Gy calculated at 1 cm from the iridium-192 wire axis. Seven patients received ILBT from the duct of Wirsung whereas two patients received dual-duct ILBT (duct of Wirsung and the common bile duct). Three patients received combined-modality treatment (ILBT with external beam radiotherapy and 5-fluorouracil). The patients were prospectively followed up.
Results: No endoscopy-related complications occurred. No radiation-related toxicity occurred in patients treated with ILBT alone. One patient undergoing combined-modality treatment developed gastric bleeding. Intraluminal source dislodgement occurred in three patients. Obvious tumor mass reduction of greater than 50 % was seen in three patients at 8 weeks after brachytherapy. Median survival was 11 months (range 6 - 37 months) and the 1-year and 3-year actuarial survival rates were 44 % and 15 %, respectively.
Conclusion: Intraluminal brachytherapy in the duct of Wirsung in patients with unresectable pancreatic carcinoma is safe and feasible. Further clinical trials are warranted.

References

  • 1 Dobelbower R R. Current radiotherapeutic approaches to pancreatic cancer.  Cancer. 1981;  47 1729-1733
    PubMedGoogle Scholar
  • 2 Borgelt B B, Dobelbower R R, Strubler K A. Betatron therapy for unresectable pancreatic carcinoma. A preliminary report.  Am J Surg. 1978;  135 76-80
    CrossrefPubMedGoogle Scholar
  • 3 Haslam J B, Cavanaugh P J, Stroup S L. Radiation therapy in the treatment of unresectable adenocarcinoma of the pancreas.  Cancer. 1973;  32 1341-1345
    PubMedGoogle Scholar
  • 4 Higgins P D, Sohn J W, Fine R M. et al . Three-dimensional conformal pancreas treatment: comparison of four-to-six-field techniques.  Int J Radiat Oncol Biol Phys. 1995;  31 605-609
    CrossrefPubMedGoogle Scholar
  • 5 Dobelbower R R, Howard J M, Bagne F R. et al . Treatment of cancer of the pancreas by precision high dose (PHD) external photon beam and intraoperative electron beam therapy (IOEBT).  Int J Radiat Oncol Biol Phys. 1989;  16 205-299
    PubMedGoogle Scholar
  • 6 Dobelbower R R, Konski A A, Merrick H W. et al . Intraoperative electron beam radiation therapy (IOEBRT) for carcinoma of the exocrine pancreas.  Int J Radiat Oncol Biol Phys. 1991;  20 113-119
    PubMedGoogle Scholar
  • 7 Sindelar W F, Kinsella T J. Studies of intraoperative radiotherapy in carcinoma of the pancreas.  Ann Oncol. 1999;  10 226-230
    CrossrefPubMedGoogle Scholar
  • 8 Pfreundner L, Baier K, Schwab F. et al . 3D-CT-planned interstitial HDR brachytherapy + percutaneous irradiation and chemotherapy in inoperable pancreatic carcinoma. Methods and clinical outcome.  Strahlenther Onkol. 1998;  174 133-141
    PubMedGoogle Scholar
  • 9 Montemaggi P, Dobelbower R, Crucitti F. et al . Interstitial brachytherapy for pancreatic cancer: report of seven cases treated with 125I and a review of the literature.  Int J Radiat Oncol Biol Phys. 1991;  21 451-457
    PubMedGoogle Scholar
  • 10 DeNittis A S, Stambaugh M D, Lang P. et al . Complete remission of nonresectable pancreatic cancer after infusional colloidal phosphorus-32 brachytherapy, external beam radiation therapy, and 5-fluorouracil: a preliminary report.  Am J Clin Oncol. 1999;  22 355-360
    CrossrefPubMedGoogle Scholar
  • 11 Westlin J E, Andersson-Forsman C, Garske U. et al . Objective responses after fractionated infusional brachytherapy of unresectable pancreatic adenocarcinomas.  Cancer. 1997;  80 2743-2748
    CrossrefPubMedGoogle Scholar
  • 12 Johnson D W, Safai C, Goffinet D R. Malignant obstructive jaundice: treatment with external-beam and intracavitary radiotherapy.  Int J Radiat Oncol Biol Phys. 1985;  11 411-416
    PubMedGoogle Scholar
  • 13 Molt P, Hopfan S, Watson R C. et al . Intraluminal radiation therapy in the management of malignant biliary obstruction.  Cancer. 1986;  57 536-544
    PubMedGoogle Scholar
  • 14 Siegel J H, Lichtenstein J L, Pullano W E. et al . Treatment of malignant biliary obstruction by endoscopic implantation of iridium 192 using a new double lumen endoprosthesis.  Gastrointest Endosc. 1988;  34 301-306
    PubMedGoogle Scholar
  • 15 Levitt M D, Laurence B H, Cameron F. et al . Transpapillary iridium - 192 wire in the treatment of malignant bile duct obstruction.  Gut. 1988;  29 149-152
    PubMedGoogle Scholar
  • 16 Montemaggi P, Morganti A G, Dobelbower R R. et al . Role of intraluminal brachytherapy in extrahepatic bile duct and pancreatic cancers: is it just for palliation?.  Radiology. 1996;  191 861-866
    PubMedGoogle Scholar
  • 17 Dumonceau J M, Deviere J, Le Moine O. et al . Endoscopic pancreatic drainage in chronic pancreatitis associated with ductal stones: long-term results.  Gastrointest Endosc. 1996;  43 547-555
    PubMedGoogle Scholar
  • 18 Miller A B, Hoogstraten B, Staquet M. et al . Reporting results of cancer treatment.  Cancer. 1981;  47 207-214
    CrossrefPubMedGoogle Scholar
  • 19 Costamagna G, Alevras P, Palladino F. et al . Endoscopic pancreatic stenting in pancreatic cancer.  Can J Gastroenterol. 1999;  13 481-487
    PubMedGoogle Scholar
  • 20 Harrison M A, Hamilton S W. Palliation of pancreatic cancer pain by endoscopic stent placement.  Gastrointest Endosc. 1989;  35 443-445
    PubMedGoogle Scholar
  • 21 Dobelbower R R, Montemaggi P. Brachytherapy for pancreatic cancer: a review.  Hepatogastroenterology. 1996;  43 333-337
    PubMedGoogle Scholar
  • 22 Bodner W R, Hilaris B S, Mastoras D A. Radiation therapy in pancreatic cancer: current practice and future trends.  J Clin Gastroenterol. 2000;  30 230-233
    CrossrefPubMedGoogle Scholar
  • 23 Johnson D W, Safai C, Goffinet D R. Malignant obstructive jaundice: treatment with external beam and intracavitary radiotherapy.  Int J Radiat Oncol Biol Phys. 1985;  11 411-416
    PubMedGoogle Scholar
  • 24 Montemaggi P, Morganti A G, Smaniotto D. et al . Carcinoma of the pancreatic head area therapy: intraluminal brachytherapy.  Rays. 1995;  20 338-349
    PubMedGoogle Scholar
  • 25 Fritz P, Brambs H J, Schraube P. et al . Combined external beam radiotherapy and intraluminal high dose rate brachytherapy on bile duct carcinoma.  Int J Radiat Oncol Biol Phys. 1994;  29 855-886
    CrossrefPubMedGoogle Scholar
  • 26 Hayes J K, Sapozink M D, Miller F J. Definitive radiation therapy in bile duct carcinoma.  Int J Radiat Oncol Biol Phys. 1988;  15 735-744
    PubMedGoogle Scholar
  • 27 Foo M L, Gunderson L L, Bender C E. et al . External radiation therapy and transcatheter iridium in the treatment of extrahepatic bile duct carcinoma.  Int J Radiat Oncol Biol Phys. 1997;  39 929-935
    PubMedGoogle Scholar
  • 28 Prott F J, Schonekaes K, Preusser P. et al . Combined modality treatment with accelerated radiotherapy and chemotherapy in patients with locally advanced inoperable carcinoma of the pancreas: results of a feasibility study.  Br J Cancer. 1997;  75 597-601
    PubMedGoogle Scholar

G. Costamagna, M.D.

Digestive Endoscopy Unit · “A. Gemelli” University Hospital

Largo A. Gemelli 8 · 00168 Rome · Italy

Fax: + 39-06-35511515

Email: gcostamagna@rm.unicatt.it

      >