, New York, NY) 1000 mg/m2 was administered as a 30 minute intravenous infusion weekly for three weeks followed by a one week rest period. Chemotherapy was omitted according to the physician’s decision if a significant hematologic or nonhematologic toxicity had not recovered on the day of therapy. Within 24 hours of infusing gemcitabine, the HIFU treatment may was conducted using the protocol described above. HIFU was generally cancelled when chemotherapy was cancelled due to an adverse reaction. However, the HIFU treatment alone was occasionally performed in cases with a long absence of treatment. Gemcitabine administration was continued until disease progression occurred.

Assessment Regarding the three patients in the CCHT group, the following were analyzed: the number of CCHT sessions, the number of HIFU alone treatments, the mean target energy per spot (J/spot), the mean input acoustic intensity (W/cm2), the mean treatment time from the first to last sonication, the serial changes in the level of the tumor marker CA 19-9, the serial changes of the tumor size by CT, the PET-CT findings if available, the OS from the time of diagnosis, the time to tumor progression (TTP), the presence of complications (redness, skin burn, treatment-related pain, pancreatitis, gastrointestinal injury and others) and the current performance status as determined by the Karnofsky scoring system. The OS was calculated from the date of diagnosis to the date of death from any cause or the last documented follow-up. The TTP was calculated from the start of treatment to the date of the first documented progression or the last follow-up.

Regarding the nine patients in the non-CCHT group, we determined the main reason why CCHT was not performed more than twice. The OS from the time of diagnosis, the TTP and the presence or absence of complications during the HIFU treatment were also analyzed. RESULTS The Concurrent Chemotherapy and Pulsed High Intensity Focused Ultrasound Therapy Group Tables 1 and and22 summarize the survival data, the treatment protocol and the complications of the CCHT group. Figures 1–33 show the serial changes in the CA 19-9 levels and the CT-determined tumor sizes. Fig. 1 60-year-old man with unresectable pancreatic cancer arising from uncinate process and encasing superior mesenteric artery. Fig.

3 61-year-old man with unresectable pancreatic head cancer with invasion to celiac axis and main portal vein. Table 2 Summary of Patients Treated Dacomitinib with Concurrent Chemotherapy and High Intensity Focused Ultrasound Treatment Patient 1 (Fig. 1) (Tables 1, ,2)2) had a 2.7 cm soft tissue lesion encasing the superior mesenteric artery (SMA) with an indistinct low attenuation area in the uncinate process of the pancreas, as seen on CT (Fig. 1A). The laparoscopic biopsy revealed atypical ductal cells and this suggested pancreatic carcinoma. PET-CT showed increased activity around the SMA.