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.
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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