Locally advanced pancreatic cancer:treatment with Nanoknife percutaneously under guidance of ultrasound and effectiveness evaluated by contrast enhanced ultrasonography / 中华超声影像学杂志

ABSTRACT

Objective To explore the treatment of locally advanced pancreatic cancer(LAPC)by Nanoknife,and the demonstrations on contrast enhanced ultrasonography(CEUS)after the procedures. Methods Four patients were enrolled.Each of them was percutaneously inserted 3-5 Nanoknife electrodes to ablate the lesions with 2-3 sessions under the guidance of ultrasound.After the procedures,CEUS, contrast enhanced CT,contrast enhanced MRI or computed tomography angiography (CTA) were performed to assess the efficacy.Results All patients uneventfully were able to tolerate the high-voltage Nanoknife procedures.However,the endurable pain or discomfort in abdomen was complained.For one patient with obstructive jaundice and mild liver dysfunction,pancreatic amylase in serum increased slightly at the first day after treatment.Furthermore,C response protein in serum elevated,and biliary tract infection happened at the third day.Moreover,thromboses in portal and splenic vein were found at the seventh day.The survival time for all cases were 3-8 months.According to the findings of CEUS,a well-defined no contrast enhancement was detected at ablative zone for all the patients within one week.Yet, contrast enhancement was sporadically detected at the periphery in 3 patients 1-2 months late.Meanwhile, on contrast enhanced CT or MRI,an area of absent enhancement was also depicted at the ablation zone with heterogeneously decreased enhancement at periphery of the lesion.Base on CTA findings,local stenosis of splenic vein and superior mesenteric vein with varices of collateral vascularity were found in one patient at the fiftieth day,and superior mesenteric vein obstruction accompanied by varices of collateral vascularity was also found in another patient at the seventieth day.Conclusions For patients with LAPC,Nanoknife treatment is a safe and convenient procedure that can be percutaneously completed under the guidance of ultrasound.Along with enhanced CT,MRI or CTA,CEUS is a promising way to evaluate the efficacy of this procedure.