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Improving quality of life in pancreatic cancer patients following high-intensity focused ultrasound (HIFU) in two European centers

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.

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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

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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.

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Corresponding author

Correspondence to Holger M. Strunk.

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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.

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Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• multi-center study

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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

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Keywords

  • Pancreatic neoplasms
  • High-intensity focused ultrasound ablation
  • Palliative care
  • Pain management
  • Quality of life