Rad-16. Percutaneous MRI guided and monitored cryosurgery of pancreatic tumors.

The purpose of this study is to develop a minimally invasive image guided treatment for inoperable pancreatic cancer. Patients with primary pancreatic tumors that were poor surgical candidates and had completed chemo and radiation therapy but had remaining measurable disease were enrolled in this Investigational Review Board approved study. Diagnostic imaging preoperatively consisted of a CT a MRI. Treatment goal was relief of pain along with destruction of measurable disease. Between August 1999 and December 2001, 3 patients underwent 4 interventional magnetic resonance imaging guided and monitored percutaneous cryosurgeries with general anesthesia. One patient was treated twice. All 3 patients had significant pain unrelieved by conventional radiotherapy. Tumor locations included the pancreatic body (2) and inferior pancreatic head (1). Adenocarcinoma cell type was confirmed by percutaneous biopsy in each case. Mean tumor diameter was 3.1 cm (2.0-4.1). Follow-up ranged from 6-24 months, with a mean of 14 months. Short- and long-term results demonstrated excellent and immediate long lasting relief of pain. Two patients were alive and free of measurable disease 6 and 24 months post cryosurgery. The third patient remained pain free until the 11th month post cryosurgery at which time she developed malignant ascites. She expired at 12 months post cryosurgery. No complications were encountered despite expectations of pancreatitis. Excellent and sustained pain relief was achieved in all three cases suggesting pain relief alone is an indication for this new therapy. A mean survival of 14 months is remarkably longer than the 6-month average published for pancreatic cancer, but one cannot claim treatment significance based on three cases with limited follow-up. The multiplanar imaging and thermal event imaging capabilities of MRI imaging were thought to be critical in measuring mortality and maximizing treatment success.

Patrick E. Sewell, Jr, MD. University of Mississippi Medical School, Department of Radiology, Division of Minimally Invasive Surgery, Jackson MI.