Abstract
Objectives
Pancreatic cancer patients often have a high symptom burden, significantly impairing patients’ quality of life (QOL). Nevertheless, there are hardly any reports on the impact of high-intensity focused ultrasound (HIFU) on the QOL of treated patients. For the first time, this study evaluated the effect of HIFU on QOL and compared these results in two European centers.
Methods
Eighty patients with advanced pancreatic cancer underwent HIFU (50 in Germany, 30 in Bulgaria). Clinical assessment included evaluation of QOL and symptoms using the EORTC QLQ-C30 questionnaire at baseline and 1, 3, and 6 months after HIFU. Pain intensity was additionally evaluated with the numerical rating score (NRS).
Results
Compared to baseline, global health significantly improved 3 and 6 months after HIFU treatment (p = 0.02). Functional subscales including physical, emotional, and social functioning were considerably improved at 6 months (p = 0.02, p = 0.01, and p = 0.01, respectively) as were leading symptom pain (p = 0.04 at 6 months), fatigue (p = 0.03 at 3 and p = 0.01 at 6 months), and appetite loss (p = 0.01 at 6 months). Moreover, pain intensity measured by NRS revealed effective and strong pain relief at all time points (p < 0.001). Reported effects were independent of tumor stage, metastatic status, and country of treatment.
Conclusions
This study showed that HIFU represents an effective treatment option of advanced pancreatic cancer improving QOL by increasing global health and mitigation of physical complaints with a low rate of side effects, independent of the examiner. Therefore, HIFU is a worthwhile additional treatment besides systemic palliative chemotherapy or best supportive care in management of this aggressive disease.
Key Points
• In a prospective two-center study, it was shown that HIFU represents an effective treatment option of advanced pancreatic cancer improving QOL.
• HIFU in pancreatic cancer patients is associated with a low rate of side effects, independent of the performer.
• HIFU is a worthwhile additional treatment besides systemic palliative chemotherapy or best supportive care in management of this aggressive disease.
Similar content being viewed by others
Abbreviations
- 5-FU/NalIRI:
-
5-Fluorouracil/nanoliposomal irinotecan
- CI:
-
Confidence intervals
- DALYs:
-
Disability-adjusted life years
- ECOG:
-
Eastern Cooperative Oncology Group
- EORTC QLQ-C30:
-
European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire, Version 3.0
- HIFU:
-
High-intensity focused ultrasound
- IRE:
-
Irreversible electroporation
- MWA:
-
Microwave ablation
- NRS:
-
Numerical rating score
- OS:
-
Overall survival
- QOL:
-
Quality of life
- RFA:
-
Radiofrequency ablation
- SD:
-
Standard deviation
- UICC:
-
Union internationale contre le cancer
- WHO:
-
World Health Organization
References
Carrato A, Falcone A, Ducreux M et al (2015) A systematic review of the burden of pancreatic cancer in Europe: real-world impact on survival, quality of life and costs. J Gastrointest Cancer 46:201–211
Robert Koch-Institut (2013) Krebs in Deutschland 2009/2010, Robert Koch-Institut and Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (Eds.), Berlin. Vol. 9. Available via https://edoc.rki.de/handle/176904/3244. Accessed 18 Jan 2021
Conroy T, Desseigne F, Ychou M et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364:1817–1825
Von Hoff DD, Ervin T, Arena FP et al (2013) Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 369:1691–1703
Wang-Gillam A, Li CP, Bodoky G et al (2016) Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial. Lancet 387:545–557
Murray CJ, Vos T, Lozano R et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2197–2223
Bernhard J, Dietrich D, Glimelius B et al (2010) Estimating prognosis and palliation based on tumour marker CA 19-9 and quality of life indicators in patients with advanced pancreatic cancer receiving chemotherapy. Br J Cancer 103:1318–1324
Dale PS, Souza JW, Brewer DA (1998) Cryosurgical ablation of unresectable hepatic metastases. J Surg Oncol 68:242–245
Goldberg SN, Gazelle GS, Mueller PR (2000) Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. AJR Am J Roentgenol 174:323–331
Keane MG, Bramis K, Pereira SP, Fusai GK (2014) Systematic review of novel ablative methods in locally advanced pancreatic cancer. World J Gastroenterol 20:2267–2278
Kovach SJ, Hendrickson RJ, Cappadona CR et al (2002) Cryoablation of unresectable pancreatic cancer. Surgery 131:463–464
Sato M, Watanabe Y, Kashu Y, Hamada Y, Kawachi K (1998) Sequential percutaneous microwave coagulation therapy for liver tumor. Am J Surg 175:322–324
Varshney S, Sewkani A, Sharma S et al (2006) Radiofrequency ablation of unresectable pancreatic carcinoma: feasibility, efficacy and safety. JOP 7:74–78
Scheffer HJ, Vroomen LG, de Jong MC et al (2017) Ablation of locally advanced pancreatic cancer with percutaneous irreversible electroporation: results of the Phase I/II PANFIRE Study. Radiology 282:585–597
Gao HF, Wang K, Meng ZQ et al (2013) High intensity focused ultrasound treatment for patients with local advanced pancreatic cancer. Hepatogastroenterology 60:1906–1910
Marinova M, Huxold HC, Henseler J et al (2018) Clinical effectiveness and potential survival benefit of US-guided high-intensity focused ultrasound therapy in patients with advanced-stage pancreatic cancer. Eur J Ultrasound 40(5):625–637
Sofuni A, Moriyasu F, Sano T et al (2014) Safety trial of high-intensity focused ultrasound therapy for pancreatic cancer. World J Gastroenterol 20:9570–9577
Vidal-Jove J, Perich E, del Castillo MA (2015) Ultrasound guided high intensity focused ultrasound for malignant tumors: the Spanish experience of survival advantage in stage III and IV pancreatic cancer. Ultrason Sonochem 27:703–706
Wang K, Chen Z, Meng Z et al (2011) Analgesic effect of high intensity focused ultrasound therapy for unresectable pancreatic cancer. Int J Hyperthermia 27:101–107
Wang K, Zhu H, Meng Z et al (2013) Safety evaluation of high-intensity focused ultrasound in patients with pancreatic cancer. Onkologie 36:88–92
Xiong LL, Hwang JH, Huang XB et al (2009) Early clinical experience using high intensity focused ultrasound for palliation of inoperable pancreatic cancer. JOP 10:123–129
Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376
Fayers PM (2001) Interpreting quality of life data: population-based reference data for the EORTC QLQ-C30. Eur J Cancer 37:1331–1334
Cameron AC, Trivedi PK (2010) Microeconometrics using STATA. Stata Press, College Station
Rabe-Hesketh S, Skrondal A (2012) Multilevel and longitudinal modeling using Stata, 3rd edn. Stata Press, College Station, pp 1–2
Syrjala KL, Jensen MP, Mendoza ME, Yi JC, Fisher HM, Keefe FJ (2014) Psychological and behavioral approaches to cancer pain management. J Clin Oncol 32:1703–1711
Seufferlein T, Porzner M, Heinemann V, Tannapfel A, Stuschke M, Uhl W (2014) Ductal pancreatic adenocarcinoma. Dtsch Arztebl Int 111:396–402
Ryan DP, Hong TS, Bardeesy N (2014) Pancreatic adenocarcinoma. N Engl J Med 371:1039–1049
Muller-Nordhorn J, Roll S, Bohmig M et al (2006) Health-related quality of life in patients with pancreatic cancer. Digestion 74:118–125
Labori KJ, Hjermstad MJ, Wester T, Buanes T, Loge JH (2006) Symptom profiles and palliative care in advanced pancreatic cancer: a prospective study. Support Care Cancer 14:1126–1133
Beesley VL, Janda M, Goldstein D et al (2016) A tsunami of unmet needs: pancreatic and ampullary cancer patients' supportive care needs and use of community and allied health services. Psychooncology 25:150–157
Marinova M, Wilhelm-Buchstab T, Strunk H (2019) Advanced pancreatic cancer: high-intensity focused ultrasound (HIFU) and other local ablative therapies. Rofo 191:216–227
Hinrichs JB, Wacker FK (2020) Locoregional and local ablative treatment options for liver tumors. Internist (Berl) 61:158–163
Wu Y, Tang Z, Fang H et al (2006) High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer. J Surg Oncol 94:392–395
Ruarus AH, Vroomen L, Geboers B et al (2020) Percutaneous Irreversible Electroporation in Locally Advanced and Recurrent Pancreatic Cancer (PANFIRE-2): a multicenter, prospective, single-arm, phase II study. Radiology 294:212–220
Lee JY, Choi BI, Ryu JK et al (2011) Concurrent chemotherapy and pulsed high-intensity focused ultrasound therapy for the treatment of unresectable pancreatic cancer: initial experiences. Korean J Radiol 12:176–186
Li PZ, Zhu SH, He W et al (2012) High-intensity focused ultrasound treatment for patients with unresectable pancreatic cancer. Hepatobiliary Pancreat Dis Int 11:655–660
Li YY, Sha WH, Zhou YJ, Nie YQ (2007) Short and long term efficacy of high intensity focused ultrasound therapy for advanced hepatocellular carcinoma. J Gastroenterol Hepatol 22:2148–2154
Sung HY, Jung SE, Cho SH et al (2011) Long-term outcome of high-intensity focused ultrasound in advanced pancreatic cancer. Pancreas 40:1080–1086
Marinova M, Strunk HM, Rauch M et al (2017) High-intensity focused ultrasound (HIFU) for tumor pain relief in inoperable pancreatic cancer: evaluation with the pain sensation scale (SES). Schmerz 31(1):31–39
Strunk HM, Henseler J, Rauch M et al (2016) Clinical use of high-intensity focused ultrasound (HIFU) for tumor and pain reduction in advanced pancreatic cancer. Rofo 188:662–670
Stone P, Richardson A, Ream E, Smith AG, Kerr DJ, Kearney N (2000) Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Cancer Fatigue Forum. Ann Oncol 11:971–975
Jacox A, Carr DB, Payne R (1994) New clinical-practice guidelines for the management of pain in patients with cancer. N Engl J Med 330:651–655
Cherny N, Ripamonti C, Pereira J et al (2001) Strategies to manage the adverse effects of oral morphine: an evidence-based report. J Clin Oncol 19:2542–2554
Cuhls H, Mücke M, Brunsch-Radbruch A et al (2014) Schmerztherapie in der Palliativmedizin - Aktuelle Aspekte der Schmerztherapie. CME 11:7–14
Wong GY, Schroeder DR, Carns PE et al (2004) Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial. JAMA 291:1092–1099
Yan BM, Myers RP (2007) Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Am J Gastroenterol 102:430–438
Acknowledgments
The authors acknowledge Guido Luechters who provided a valuable support and advice in all statistical questions at any time.
Funding
The authors state that this work has not received any funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Guarantor
The scientific guarantor of this publication is:
Name: Assoc. Prof. Dr. Milka Marinova
Address: Venusberg-Campus 1
Post code: 53127
City: Bonn
Country: Germany
Telephone: +49-228-287-19055
Fax: +49-228-287-9011017
Email: milka.marinova@ukbonn.de
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
Guido Luechters kindly provided statistical advice for this manuscript.
Informed consent
Written informed consent was waived by the Institutional Review Board.
Ethical approval
Institutional Review Board approval was obtained.
Methodology
• prospective
• diagnostic or prognostic study
• multi-center study
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Marinova, M., Feradova, H., Gonzalez-Carmona, M.A. et al. Improving quality of life in pancreatic cancer patients following high-intensity focused ultrasound (HIFU) in two European centers. Eur Radiol 31, 5818–5829 (2021). https://doi.org/10.1007/s00330-020-07682-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-020-07682-z