Analgesic effect of high intensity focused ultrasound therapy for unresectable pancreatic cancer

Figures & data

Table I.  Patient characteristics and therapeutic parameters.

Characteristics	Value n (%)
Sex
Male	24 (60)
Female	16 (40)
Karnofsky performance status
90	1 (2.5)
80	7 (17.5)
70	32 (80)
Site of disease
Pancreatic head	9 (22.5)
Body and/or tail	31 (77.5)
Stage of disease
III	13 (32.5)
IV	27 (67.5)
CA19-9
Positive	33 (82.5)
Negative	7 (17.5)
Prior chemotherapy-treated	35 (87.5)
Simultaneous radiotherapy-treated	7 (17.5)
	Value
Age (years)
range (median)	31–80 (57)
Maximum tumour size (mm)
Range (median)	20–100 (43)
Planning target volume (cm3)
Range (median)	9.2–102.1 (22.7)
Total therapeutic time (h)
Range (mean)	0.75–3.2 (2.1)
Ultrasonic mean-power (W)
Range (median)	117–388 (247)
Acoustic energy (kJ)
Range (median)	83.7–1194.6 (294.8)

Figure 1. Curve of pain relief time. This is a PRT curve of all 40 patients, median PRT was 10 weeks (95% confidence interval, 7.7–12.3)

Table II.  Pain control with HIFU therapy.

Pain	n (%)
	Entire relief*	Partial relief	Not relief
Mild	6 (54.5)	4 (36.4)	1 (9.1)
Moderate	3 (11.5)	19 (73.1)	4 (15.4)
Severe	–	3 (100)	–
Unbearable	–	–	–
Total	9 (22.5)	26 (65)	5 (12.5)

*Pain numerical rating scores (NRS ≤ 1) after HIFU.

Figure 2. Gray-scale changes of HIFU obtained on real-time ultrasound (US) images during HIFU procedure. (a) US image obtained before HIFU shows a large pancreatic carcinoma lesion present in the body of the pancreas. (b) US images obtained during the HIFU procedure show hyperechogenicity in the treated tumour (arrows). (c) US images obtained immediately after the one-slice HIFU procedure show the hyperechogenicity of treated tumour in the one slice lesion (arrows). (d, e) Transverse contrast-enhanced conventional CT scans obtained before (d) and 1 month after (e) HIFU ablation. There was an obvious regression (arrows) in lesion size of primary tumour after HIFU despite the progress of the liver metastases. All five images are taken from the same patient.

Figure 3. (a, b) Gray-scale changes of HIFU obtained on real-time ultrasound (US) images during HIFU procedure. (a) US image obtained before HIFU shows a large pancreatic carcinoma lesion present in tail of pancreas. (b) US images obtained immediately after HIFU procedure show the hyperechogenicity (arrows) of treated tumour in the one slice lesion. (c) A CT scan made before HIFU demonstrates a tumour in the tail of the pancreas. (d) A CT scan demonstrates no significant size change one month after HIFU treatment. (e) A PET-CT scan made before HIFU demonstrates a SUVmax of 7.5g/mL. (f) The PET-CT scan made 3 months after HIFU demonstrates coagulative necrosis inside the tumour and the decreasing of the SUV_max value to 5.3 g/mL. All images are taken from the same patient.

Figure 4. Time to local-PFS and OS. This is a Kaplan Meir survival curve of all 40 patients. The median local-PFS time for all patients was 5 months (95%CI, 4.6–5.4). The median OS time was 8 months (95%CI, 4.5–11.5).