The Impact of Combined Chemotherapy and Intra-Tumoural Injection of Phosphorus-32 Microparticles on Vascularity in Locally Advanced Pancreatic Carcinoma

Poor intra-tumoural vascularity contributes to a lack of response to chemotherapy in pancreatic cancers. Preliminary data suggest that the addition of endoscopic ultrasound (EUS)-guided intra-tumoural injection of phosphorus-32 ( P) microparticles to standard chemotherapy is potentially beneficial i...

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Bibliographic Details
Published in:Cancers 2024-10, Vol.16 (19), p.3412
Main Authors: Lim, Amanda Huoy Wen, Zobel, Joshua, Bills, Madison, Hsieh, William, Crouch, Benjamin, Joshi, Rohit, Thomson, John-Edwin, Neo, EuLing, Kuan, Li Lian, Safaeian, Romina, Tse, Edmund, Rayner, Christopher K, Ruszkiewicz, Andrew, Singhal, Nimit, Bartholomeusz, Dylan, Nguyen, Nam Quoc
Format: Article
Language:English
Subjects:
Abdomen
Adenocarcinoma
Angiogenesis
Blood tests
Blood-vessels
Cancer therapies
Chemotherapy
Chemotherapy, Combination
Clinical trials
Disease control
Drug therapy
Endoscopy
Global health
Health aspects
Hypoxia
Investigations
Medical prognosis
Metastases
Metastasis
Methods
Microparticles
Pancreatic cancer
Pancreatic carcinoma
Patient outcomes
Patients
Phosphorus
Phosphorus compounds
Questionnaires
Radiation therapy
Radioisotope brachytherapy
Survival
Tomography
Tumors
Ultrasonic imaging
Ultrasound
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Summary:Poor intra-tumoural vascularity contributes to a lack of response to chemotherapy in pancreatic cancers. Preliminary data suggest that the addition of endoscopic ultrasound (EUS)-guided intra-tumoural injection of phosphorus-32 ( P) microparticles to standard chemotherapy is potentially beneficial in locally advanced pancreatic cancer (LAPC). We aimed to assess changes in pancreatic tumour vascularity following P implantation, using contrast-enhanced EUS (CE-EUS). This was a prospective single-centre trial from January 2022 to 2024 of patients with unresectable, non-metastatic LAPC undergoing standard FOLFIRINOX chemotherapy and P implantation. We performed CE-EUS pre-implantation after two chemotherapy cycles and 4 and 12 weeks after implantation. Time-intensity curves were analysed for 90 s after IV contrast bolus to ascertain peak intensity and intensity gain. A total of 20 patients underwent P implantation, with 15 completing 12-week follow-up. The technical success of P implantation was 100%. The median primary tumour size reduced from 32 mm (IQR 27.5-38.75) pre-implantation to 24 mm (IQR 16-26) 12 weeks post-implantation ( < 0.001). Five patients (25%) had tumour downstaging, and four underwent resections. The baseline (pre-implantation, post-chemotherapy) median intensity gain of contrast enhancement within the tumour was 32.15 (IQR 18.08-54.35). This increased to 46.85 (IQR 35.05-76.6; = 0.007) and 66.3 (IQR 54.7-76.3; = 0.001) at 4 weeks and 12 weeks post-implantation, respectively. Over a median follow-up of 11.2 months (IQR 7.8-12.8), 15/20 (75%) of patients remained alive, with 3/20 (15%) demonstrating local disease progression. Overall survival was not significantly different between patients with or without an increased intensity of 10 a.u. or more at 12 weeks post-implantation. This is the first clinical study to demonstrate treatment-induced increased vascularity within pancreatic primary tumours, which followed P implantation and FOLFIRINOX chemotherapy. Larger comparative trials are warranted.
ISSN:2072-6694
2072-6694
DOI:10.3390/cancers16193412