长期随访显示化疗的耐久性，用于消融和分辨粘膜胰腺囊肿

A decade ago, a team of researchers at118金宝搏抽水Penn State Health Milton S. Hershey Medical Center开始开发一种更安全，更微创的方法来治疗粘液（癌前）胰腺囊性病变。大约2％的美国人都有这些前癌症囊肿，导致所有胰腺癌患者的15％至20％。Endoscopic ultrasound (EUS)-guided pancreatic cyst ablation is an innovative and emerging technique of eliminating mucinous pancreatic cysts without the need for surgery in appropriately selected patients.

Results of Penn State Health’s Chemotherapy for Ablation and Resolution of Mucinous pancreatic cysts (CHARM) trial, published in August 2017, showed that using an innovative cocktail of paclitaxel, gemcitabine and alcohol-free saline essentially eliminated associated adverse events when compared with previously used, alcohol-based ablation protocols (which carried a 3% to 10% risk of serious adverse events).¹ This significantly improved the safety of the procedure, paving the way for broader adoption of this approach internationally.

The CHARM study sparked a second multicenter clinical trial, CHARM II, funded by the National Institutes of Health.² While CHARM II will continue through 2023, in the interim, researchers at the Milton S. Hershey Medical Center wanted to evaluate the long-term durability of this innovative, alcohol free chemoablation treatment.

“With surgery, we know a pre-cancerous cyst is gone, but with ablation, we didn’t have objective evidence on whether the cysts are completely eradicated without long-term follow-up analysis,” said gastroenterologistDr. Matthew T. Moyerwith Hershey Medical Center.

To conduct that analysis, Moyer and his research team recorded the baseline, 12-month and long-term follow-up radiology images for 36 of the 39 patients treated in the initial CHARM trial. The results, published in April 2021 in Clinical Gastroenterology and Hepatology, proved the durability of the new treatment. A total of 20 of the 23 complete responders (87%) treated with EUS-guided chemoablation maintained resolution at three to five years of follow-up. The results also suggested the possibility of protracted treatment effects because 31% of patients who did not achieve complete response initially continued toward resolution.³

“Patients who received a complete response stayed in complete response long term, and not a single patient — whether or not they received a complete response initially — developed any worrisome tumors or high-grade pathology long term,” Moyer said.

Moyer hopes the results lead to more widespread acceptance of this alcohol-free, EUS-guided chemoablation protocol. “We’re essentially taking the concept of colonoscopy for cancer screening and prevention and applying it to pancreatic cancer,” Moyer said. “Eliminating these cystic tumors from progressing to pancreatic cancer through chemoablation is minimally invasive, cost effective and tremendously more effective than waiting for cancer to develop.”

多学科的成员肝、Pancreas and Foregut Committee at Penn State Cancer Institute currently use the alcohol-free ablation protocol in clinical practice for appropriately selected patients. “It’s an exciting, minimally invasive treatment option for patients who have pre-cancerous cysts that are large enough to be worrisome, but haven’t yet progressed to have overt signs of pancreatic cancer.” Other centers have reached out to Moyer and his team to learn how to set up a programs at their institutions.

Moyer对耐久性研究的共同作者是Dr. Abraham Mathew,Dr. John Levenick, certified physician assistantBrandon Headlee.,Jennifer Maranki博士和查尔斯博士染料，来自胃肠病学和肝脏的划分;Leonard Walsh博士和Kayla Hartz博士在医疗中心举行了一般内科部门;Heather Heisey，宾夕法尼亚州调查药物服务药房;Dr. James Birkholz，放射科;和Dr. Matthew Dixon随着手术肿瘤学的分裂。

“我也想认识到克里斯托弗博士SciaManna关于一般内科的划分，帮助我们编写并成功获得魅力二审判的资助;印第安纳大学医学院John Dewitt博士;我们原始的研究协调员，Brooke ancrile，phd;还有几个值得承认使魅力系列的研究试验如此成功。“

参考

1. Moyer MT, Sharzehi S, Mathew A, et al. The Safety and Efficacy of an Alcohol-Free Pancreatic Cyst Ablation Protocol.胃肠病学。2017; 153（5）：1295-1303。doi:10.1053/j.gastro.2017.08.009
2. CHARM II: Chemotherapy for Ablation and Resolution of Mucinous Pancreatic Cysts (CHARM). National Institutes of Health U.S. National Library of Medicine ClinicalTrials.gov website.https://clinicaltrials.gov/ct2/show/NCT03085004。Updated March 26, 2021. Accessed July 16, 2021.
3. Lester C，Walsh L，Hartz Km，等。粘液胰囊肿的EUS引导式化疗的耐久性：魅力试验的长期随访[在线发布于印刷，2021年4月1日]。Clin Gastroenterol Hepatol。2021;S1542-3565(21)00351-7.doi:10.1016/j.cgh.2021.03.041