Sadly, in July 2009, he succumbed to the biliary sepsis. Complications of the Concurrent Chemotherapy and Pulsed High Intensity Focused Ultrasound Therapy Group Ponatinib TNKS2 Of the 32 CCHTs and six HIFU alone treatments administered in the CCHT group, a superficial grade 2 skin burn occurred in patient 3, and a grade 1 skin burn was noted in patients 1, 2 and 3. The grade 2 skin burn measured approximately 4 �� 5 cm in size and it required silver sulfadiazine ointment and a sterile gauze bandage for two weeks. It resolved completely within three weeks. The two grade 1 skin burns recovered without treatment within one week. No major complications such as gastrointestinal perforation or pancreatitis were encountered in the CCHT group.

Mild abdominal pain was reported during treatment (during 2 sessions in patient 1, during 6 sessions in patient 2 and during 2 sessions in patient 3). Moderate abdominal pain was noted during one session in patient 1, during two sessions in patient 2 and during one session in patient 3. However, the pain was controlled with Fentanyl, and it disappeared immediately after completing the HIFU treatment. Non-Concurrent Chemotherapy and Pulsed High Intensity Focused Ultrasound Therapy Group The patients in this group did not undergo CCHT more than twice for the following reasons: intolerance of pain during treatment (n = 4), a poor physical condition due to disease progression (n = 3), palliative use of HIFU for pain relief (n = 1) and pancreatitis (n = 1). The patient who developed pancreatitis after the HIFU treatment had a small cystic portion close to the pancreatic cancer before treatment, which was probably a pseudocyst.

This cystic lesion was included in the treatment field. Two weeks after the 3rd HIFU treatment, a large pseudocyst surrounded by inflammatory changes occurred in the mesentery anterior to the pancreas. This complication might have been caused by the delayed perforation of the cyst near the pancreatic tumor due to damage of the cystic wall by HIFU. All four patients in whom the HIFU treatment had been terminated due to severe pain during treatment were treated with more than 900 J/spot. The use of a high HIFU energy (> 900 J/spot) was favored for approximately two months after initiating HIFU treatment at our center, yet it frequently caused severe abdominal pain. Accordingly, the energy delivered was lowered to < 800 J/spot, and patients have since felt more comfortable during treatment. The patient who underwent HIFU for pain palliation did experience improvement of their pain (numeric pain scale 7 �� 3). The median OS and TTP of this group were 10.3 months (95% confidence interval Carfilzomib [CI]: 1.4-19.3) and 4.4 months (95% CI: 0.0-9.0), respectively.