Combined treatment of patients with localized pancreatic cancer of elderly and senile age

Abstract

Introduction. The gold standard for the treatment of patients with a localized form of pancreatic cancer is radical surgical intervention. It is characterized by a high frequency of postoperative complications and is not performed in patients with a weakened general functional status and the presence of multiple severe concomitant somatic pathology.Purpose. The aim of this study is a assessment of the safety and effectiveness of combined treatment with the inclusion of gemcitabine chemotherapy and HIFU therapy in somatically inoperable patients with localized pancreatic adenocarcinoma of the elderly and senile age.Materials and methods. This study involved 15 patients with stage II (T3N0-1M0) disease aged 60 years and older, with a performance status ECOG 2 and a high operational and anesthetic risk, who received palliative combined treatment on the basis of the P. Hertsen Moscow Oncology Research Institute in the period from 2017 to 2020. HIFU therapy was performed on the HIFU2001 (Shenzhen Huikang Medical Apparatus Co., Ltd.), local treatment sessions were carried out in the amount of 3–8 per course, conducted daily, in the intervals between days of intravenous administration of gemcitabine at a dosage of 1000 mg/m2 (1, 8, 15 days every 4 weeks).Results. Adverse events of systemic drug therapy were observed in 9 (60%) patients, local complications of HIFU therapy — in 6 (37.5%) patients. 6 months after the start of treatment, pain control was achieved in 87.5% of patients, local progression of the disease was detected in 2 (13.3%) cases, and a partial tumor response was determined in 2 patients and stable disease in 11 patients. The median overall survival was 19 months, and the median progression-free survival was 12 months. The overall 1-, 2-, and 3-year survival rate was 80%, 20%, and 13%, respectively, and the 1-year progression-free survival rate was 54%.Conclusions. The results of this study demonstrate the prospects of using a combination of HIFU therapy and gemcitabine monotherapy in somatically inoperable patients with localized pancreatic adenocarcinoma of the elderly and senile age.