Endoscopic ultrasound (EUS) and the management of pancreatic cancer

Yousaf, Muhammad N.; Chaudhary, Fizah S; Ehsan, Amrat; Suarez, Alejandro L.; Muniraj, Thiruvengadam; Jamidar, Priya A.; Aslanian, Harry R.; Farrell, James J.

doi:10.1136/bmjgast-2020-000408

Cited by 48 publications

(43 citation statements)

References 126 publications

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“…Due to variation in the size, depth, and location of pancreatic tumors, simulations with varying applicator geometries incorporating different patient anatomy models illustrated the feasibility of delivering hyperthermia across different tumor sizes and positions in the pancreas. As reported in the literature for endoscopic ultrasound imaging [56][57][58] and confirmed in this study, the tumors in the body and tail of the pancreas can be accessed from the body of the stomach, whereas manipulating the stomach wall and positioning the applicator toward the pylorus would provide access to regions within the head of the pancreas. By selection of device balloon diameter and careful consideration of the applicator dimensions and frequency, depth of treatment from the luminal wall as well as dimensions of the therapeutic zone encompassing an effective margin around the tumor can be estimated a priori.…”

Section: Discussionsupporting

confidence: 75%

Deployable ultrasound applicators for endoluminal delivery of volumetric hyperthermia

Zubair

Adams

Diederich

2021

International Journal of Hyperthermia

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Purpose: To investigate the design of an endoluminal deployable ultrasound applicator for delivering volumetric hyperthermia to deep tissue sites as a possible adjunct to radiation and chemotherapy. Method: This study considers an ultrasound applicator consisting of two tubular transducers situated at the end of a catheter assembly, encased within a distensible conical shaped balloon-based reflector that redirects acoustic energy distally into the tissue. The applicator assembly can be inserted endoluminally or laparoscopically in a compact form and expanded after delivery to the target site. Comprehensive acoustic and biothermal simulations and parametric studies were employed in generalized 3D and patient-specific pancreatic head and body tumor models to characterize the acoustic performance and evaluate heating capabilities of the applicator by investigating the device at a range of operating frequencies, tissue acoustic and thermal properties, transducer configurations, power modulation, applicator positioning, and by analyzing the resultant 40, 41, and 43 C isothermal volumes and penetration depth of the heating volume. Intensity distributions and volumetric temperature contours were calculated to define moderate hyperthermia boundaries. Results: Parametric studies demonstrated the frequency selection to control volume and depth of therapeutic heating from 62 to 22 cm 3 and 4 to 2.6 cm as frequency ranges from 1 MHz to 4.7 MHz, respectively. Width of the heating profile tracks closely with the aperture. Water cooling within the reflector balloon was effective in controlling temperature to 37 C maximum within the luminal wall. Patient-specific studies indicated that applicators with extended OD in the range of 3.6-6.2 cm with 0.5-1 cm long and 1 cm OD transducers can heat volumes of 1.1-7 cm 3 , 3-26 cm 3 , and 3.3-37.4 cm 3 of pancreatic body and head tumors above 43, 41, and 40 C, respectively. Conclusion:In silico studies demonstrated the feasibility of combining endoluminal ultrasound with an integrated expandable balloon reflector for delivering volumetric hyperthermia in regions adjacent to body lumens and cavities.

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Section: Discussionsupporting

confidence: 75%

Deployable ultrasound applicators for endoluminal delivery of volumetric hyperthermia

Zubair

Adams

Diederich

2021

International Journal of Hyperthermia

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“…While MRI is not as widely used as CT for initial diagnosis, it is more efficient in detecting small tumors, metastatic lesions in liver peritoneum and lymph nodes (LN), and identifying malignant cystic lesions of the pancreas 175 , 176 . Endoscopic ultrasound (EUS) is highly sensitive in detecting small tumors that are often missed by other imaging modalities, and it also provides an opportunity to collect samples (fine needle aspirates) for cytological or biomarker analysis to facilitate the most conclusive diagnosis 177 . Metabolic PET imaging, which relies on the differential uptake of 18 F-labeled fluoro-deoxy glucose (FDG) by rapidly growing tumor cells, enables whole-body imaging to detect both primary tumors and metastasis and is used alone or in combination with CT and MRI for evaluating the response to therapy in PDAC patients 178 , 179 .…”

Section: Nanocarrier-based Delivery Of Therapeutic Imaging and Theran...mentioning

confidence: 99%

Nanocarriers for pancreatic cancer imaging, treatments, and immunotherapies

Liu¹,

Kshirsagar²,

Gautam³

et al. 2022

Theranostics

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Pancreatic tumors are highly desmoplastic and immunosuppressive. Delivery and distribution of drugs within pancreatic tumors are compromised due to intrinsic physical and biochemical stresses that lead to increased interstitial fluid pressure, vascular compression, and hypoxia. Immunotherapy-based approaches, including therapeutic vaccines, immune checkpoint inhibition, CAR-T cell therapy, and adoptive T cell therapies, are challenged by an immunosuppressive tumor microenvironment. Together, extensive fibrosis and immunosuppression present major challenges to developing treatments for pancreatic cancer. In this context, nanoparticles have been extensively studied as delivery platforms and adjuvants for cancer and other disease therapies. Recent advances in nanotechnology have led to the development of multiple nanocarrier-based formulations that not only improve drug delivery but also enhance immunotherapy-based approaches for pancreatic cancer. This review discusses and critically analyzes the novel nanoscale strategies that have been used for drug delivery and immunomodulation to improve treatment efficacy, including newly emerging immunotherapy-based approaches. This review also presents important perspectives on future research directions that will guide the rational design of novel and robust nanoscale platforms to treat pancreatic tumors, particularly with respect to targeted therapies and immunotherapies. These insights will inform the next generation of clinical treatments to help patients manage this debilitating disease and enhance survival rates.

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“…On the contrary, endoscopic ultrasound (EUS) is a sensitive method for identification of small lesions of the pancreas which can be subsequently focused for fine needle aspiration biopsy (FNAB). EUS is more sensitive than CT, especially for small lesions ( 2 cm) and it is also most reliable in evaluation of infiltration of large visceral vessels and lymph node involvement [28].…”

Section: Screening and Diagnostics Of Pcmentioning

confidence: 99%