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EDITORIAL
Year : 2018  |  Volume : 14  |  Issue : 7  |  Page : 1453-1454

A valuable guideline of radioactive 125I seeds interstitial implantation brachytherapy for pancreatic cancer


1 Department of Radiology, Ben Gurion University, Israel
2 Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan, China

Date of Web Publication19-Dec-2018

Correspondence Address:
Xin Ye
Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_726_18

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How to cite this article:
Hertzanu Y, Ye X. A valuable guideline of radioactive 125I seeds interstitial implantation brachytherapy for pancreatic cancer. J Can Res Ther 2018;14:1453-4

How to cite this URL:
Hertzanu Y, Ye X. A valuable guideline of radioactive 125I seeds interstitial implantation brachytherapy for pancreatic cancer. J Can Res Ther [serial online] 2018 [cited 2019 Oct 14];14:1453-4. Available from: http://www.cancerjournal.net/text.asp?2018/14/7/1453/247727



The guidelines for brachytherapy with interstitial 125I seed implantation for pancreatic cancer written by Gai Baodong for the multidisciplinary expert panel offer a major advance in the management of this hard to treat a type of cancer.

Due to its retroperitoneal location, most patients with pancreatic cancer present with advanced disease. Less than 20% of patients present with surgically resectable tumors and prognosis remains poor.[1],[2] While the results of brachytherapy appear promising and represent a major advance in the management of this disease regardless of stage, it is difficult to accurately assess the efficacy, since, as stated in the introduction, methods vary from center to center even though they all follow the same basic principle.

The gold standard assessing the efficacy of any medical treatment is randomized clinical trials, which are considered the level of evidence. When the treatment effect is small, or where long follow-up is necessary to determine the treatment effect this is certainly true, but when the magnitude of the treatment effect is large, a large case series is equally reliable. In the case of brachytherapy for pancreatic cancer, the treatment effect seems to be large but is hard to assess accurately due to the variety of protocols used in different centers. Furthermore, brachytherapy appears to be effective in both operable and inoperable pancreatic cancer, so stratification of patients is highly important.

Consequently, it is highly desirable that centers with expertise in the technology adopt a uniform approach, and that methods are standardized across centers of excellence in its application.[3],[4] Such standardization will permit an accurate assessment of the efficacy and risk-benefit ratio in different stages of the disease.[5],[6] The guidelines presented in this article are a large step forward in this direction. However, they should be viewed as an initial step in the long road toward the optimal application of the technology. Fine-tuning based on outcome data is likely to improve results and reduce the risk of complications.

Since China has been a pioneer in developing the technology, and the studies published so far mostly originated here, it is befitting that the guidelines will be publish by this multidisciplinary panel. As the procedure is being fine-tuned, I believe that it will be adopted in other countries, and studies from abroad will further define its application in other ethnic groups of patients. Standard procedures for permanent seed implantation brachytherapy ensure to reach satisfactory clinical efficacies on pancreatic cancers. More importantly, ideal seeds distribution and pre-/post-plan dose validation are one of the main challenges for pancreatic cancer brachytherapy. Further studies on brachytherapy dosimetry should be focused and warranted in the future.



 
 > References Top

1.
Kamisawa T, Wood LD, Itoi T, Takaori K. Pancreatic cancer. Lancet 2016;388:73-85.  Back to cited text no. 1
    
2.
Ilic M, Ilic I. Epidemiology of pancreatic cancer. World J Gastroenterol 2016;22:9694-705.  Back to cited text no. 2
    
3.
Saito S, Ye X. Expert consensus workshop report: Guideline for three-dimensional-printing template-assisted computed tomography-guided 125I seeds interstitial implantation brachytherapy. J Cancer Res Ther 2017;13:605-6.  Back to cited text no. 3
    
4.
Wang J, Zhang F, Guo J, Chai S, Zheng G, Zhang K, et al. Expert consensus workshop report: Guideline for three-dimensional printing template-assisted computed tomography-guided 125I seeds interstitial implantation brachytherapy. J Cancer Res Ther 2017;13:607-12.  Back to cited text no. 4
    
5.
Coveler AL, Herman JM, Simeone DM, Chiorean EG. Localized pancreatic cancer: Multidisciplinary management. Am Soc Clin Oncol Educ Book 2016;35:e217-26.  Back to cited text no. 5
    
6.
Aoyama T, Kazama K, Murakawa M, Atsumi Y, Shiozawa M, Ueno M, et al. Safety and feasibility of enhanced recovery after surgery in the patients underwent distal pancreatectomy for pancreatic cancer. J Cancer Res Ther 2018;14:S724-9.  Back to cited text no. 6
    




 

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