Intraoperative ultrasound-guided iodine-125 seed implantation for unresectable pancreatic carcinoma

BACKGROUND: To assess the feasibility and efficacy of using (125)I seed implantation under intraoperative ultrasound guidance for unresectable pancreatic carcinoma. METHODS: Fourteen patients with pancreatic carcinoma that underwent laparotomy and considered unresectable were included in this study. Nine patients were pathologically diagnosed with Stage II disease, five patients with Stage III disease. Fourteen patients were treated with (125)I seed implantation guided by intraoperative ultrasound and received D(90 )of (125)I seeds ranging from 60 to 140 Gy with a median of 120 Gy. Five patients received an additional 35–50 Gy from external beam radiotherapy after seed implantation and six patients received 2–6 cycles of chemotherapy. RESULTS: 87.5% (7/8) of patients received partial to complete pain relief. The response rate of tumor was 78.6%, One-, two-and three-year survival rates were 33.9% and 16.9%, 7.8%, with local control of disease achieved in 78.6% (11/14), and the median survival was 10 months (95% CI: 7.7–12.3). CONCLUSION: There were no deaths related to (125)I seed implant. In this preliminary investigation, (125)I seed implant provided excellent palliation of pain relief, local control and prolong the survival of patients with stage II and III disease to some extent.