Primary Clinical Study of CT-guided Iodine-125 Seed Implantation Therapy in Patients with Advanced Pancreatic Cancer 上海交通大学医学院附属瑞金医院卢湾分院 王忠敏,Brachytherapy,1898年居里夫人发现镭 1905年即进行了第1例镭针插管治疗 1930年Paterson及Parker建立了曼切斯特（Manchester）系统 1935年小居里夫妇发现了人工放射性同位素 80年代中期，现代近距离治疗迅速发展,生物学优势（外放疗相比）,肿瘤局部治疗的持续时间长 放射治疗的剂量较低 对周围正常组织的损伤小 对肿瘤细胞的杀伤力强,Implant radioactive seeds into tumors,Emit continueous low energy rays,Injury of tissues and cells,Cell death and mutation leading to cancer,Interact with biomacromolecule,Animal experiment,Clinical research,Human pancreatic cancer Sw1990 cell BABL/c was inoculated into the dorsal side of right lower extremity inguinal region of nude mice Passaged for 3 tims subcutaneously, initiate the experiments after tumor formation was stablized,Experimental design,Subcutaneous pancreatic cancer xenograft in nude mice,Seed implantation group,Control group,Experimental method,Change of xenograft volume in nude mice,Comparison of tumor inhibition rate,Obvious liquefaction necrosis can be seen in the centeral area of Experimental group tumor, there are sparse cells aroud the necrosis area (100),HE staining,There is no or little necrosis area in center of control group tumor, there are multiple tumor cells (100),Experimental group positive TK1 staining cells are exiguous（200）,Control group positive TK1 staining cells are abundent （200）,HE staining,碘-125放射粒子组织间植入治疗属放射治疗， 对周围正常器官组织无明显放射损伤 裸鼠移植瘤组织植入碘-125粒子后，实验组心、 肺、肝、肾、脾脏外观大致正常，病理检查未 见明显放射性炎症表现,Preliminary result,ZM. Wang MD, Shanghai Ruijin Hospital,Introduction,Pancreatic cancer is a devastating disease and the prognosis remains poor Few patients are eligible for curative surgical resection Alternative therapeutic options are in demand,Traditional therapy vs. External irradiation therapy vs. percutaneous seed implantation,ZM. Wang MD, Shanghai Ruijin Hospital,External irradiation therapy was regarded as insensitive to pancreatic cancer and associated with more systemic side effects Radioactive iodine-125 seed implantation has minimal surgical trauma and few complications The most commonly used isotope is iodine-125 125I placement was routinely used at our institution for recurrent tumors at various sites The aim of this study was to test its feasibility for pancreatic lesions,Current Controversies,11th IO 2010, May 23,Methods and materials,Patient population December 2004 to August 2007, 31 consecutive patients were included in this prospective, nonrandomized study Patients were diagnosed by CT or MRI with histological confirmation of the diagnosis by FNA All patients enrolled displayed contraindications to surgery or had rejected surgical treatment due to personal reasons,ZM. Wang MD, Shanghai Ruijin Hospital,Methods and materials,The total volume of each tumor was calculated with the treatment planning system (TPS) before implantation The expected number of implanted seed was calculated according to the modified level formula Patients were kept in our radiooncology/interventional ward with an usual stay of 4 full days,Methods and materials,Clinical benefit response was derived from measurement of pain, functional impairment and weight loss Patients were examined by CT after the operation Response rate was defined as the sum of CR and PR Local tumor control was defined as the absence of tumor progression (SD+PR+CR),Methods and materials,10 patients received concurrent chemotherapy with arterial infusion of gemcitabin and 5-fluorouracil (5-Fu) Chemotherapy was initiated one week after and repeated up to four cycles Follow-up visits at 1 month, 3 month, and every 3 months for clinical examination, blood sampling, and CT examination,ZM. Wang MD, Shanghai Ruijin Hospital,适应症,实体瘤（如前列腺癌）的根治性治疗 实体瘤术后残余组织的预防性治疗 转移性肿瘤病灶或术后孤立性肿瘤转移灶而失去手术价值者 无法手术的原发肿瘤的姑息性治疗,禁忌证,放射性治疗不宜(如血液病等)及有麻醉禁忌等 病灶范围广泛 恶液质、全身衰竭 肿瘤部位有活动性出血、坏死或溃疡 严重糖尿病,Iodine-125 Therapy in Advanced Pancreatic Cancer,Results,Change of Karnofsky physical score % (cases),Results,Change of pain score % (cases),Iodine-125 Therapy in Advanced Pancreatic Cancer,Results,Overall responding rate (CR+PR) =61.3% Local tumor control rate was 90.3% Median survival time for the whole group was 10.31 months Median survival time for pure seeds implantation (21 cases) was 7 months median survival time for drug-seeds combined was 11 month,Pre-implant CT scan (Case one),ZM. Wang MD, Shanghai Ruijin Hospital,Post-implant CT scan,ZM. Wang MD, Shanghai Ruijin Hospital,Pre-implant CT scan (Case Two),术后CT扫描,术中穿刺碘粒子植入,Post-implant CT scan,Post-implant CT scan,病例2 男性 76岁 胰腺癌（胰体尾部）,Pre-implant CT scan (Case Three),术后CT扫描,Post-implant CT scan,Pre-implant CT scan (Case Four),Post-implant CT scan,术后CT二维重建,Post-implant CT scan,Complications,No serious complications encountered 2 seeds of radioactive 125I found to migrate to liver in 2 patients Leukopenia and renal function impairment were found in 4 patients of drug-seeds combination group,Iodine-125 Therapy in advanced Pancreatic Cancer,Discus