Locally Advanced Pancreatic Cancer: Percutaneous Management Using Ablation, Brachytherapy, Intra-arterial Chemotherapy, and Intra-tumoral Immunotherapy

Timmer, Florentine E. F.; Geboers, Bart; Nieuwenhuizen, Sanne; Schouten, Evelien A.C.; Dijkstra, Madelon; Vries, Jan J. J. de; Tol, M. Petrousjka van den; Gruijl, Tanja D. de; Scheffer, Hester J.; Meijerink, Martijn R.

doi:10.1007/s11912-021-01057-3

Cited by 14 publications

(9 citation statements)

References 113 publications

(135 reference statements)

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“…Iodine-125 ( 125 I) seed implantation is a type of brachytherapy or interventional radiotherapy that has been used in the treatment of pancreatic neoplasm for decades. Because 125 I seeds can be placed directly within the tumor and have a small radiation radius, a high radioactive dose can be used to kill nearby tumor cells without causing significant collateral damage to surrounding tissues [41]. Pancreatitis, fistulas, seed migration, ulcers, infections, leaks, and intestinal perforations are the most common (significant) consequences of percutaneous 125 I seed implantation [42].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of 125I Seed Brachytherapy Combined with Gemcitabine Containing Chemotherapy for Unresectable Pancreatic Neoplasm—A Meta-Analysis

Yang¹,

Yang²,

Cong³

et al. 2022

JCMP

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These instructions provide you guidelines for preparing papers for Journal of Innovation and Social Science Research. Use this document as a template and as an instruction set. PURPOSE: The goal of this meta-analysis was to look at the efficacy and safety of radioactive seeds brachytherapy using Iodine-125 for unresectable advanced pancreatic neoplasm. METHODS AND MATERIALS: In pancreatic neoplasm, trials comparing 125I brachytherapy with Gemcitabine chemotherapy have been identified. The pooled odds ratios for overall response rate (ORR), disease control rate (DCR), and complications, as well as the pooled hazard ratios for progression free survival (PFS) and overall survival, were calculated using meta-analysis (OS). RESULTS: A total of 12 studies with a total of 863 cases were included. There were significant differences in ORR (OR=3.13, 95% CI 2.24-4.38) and DCR (OR=3.67, 95% CI 2.63-5.12) between 125I brachytherapy combined with chemotherapy containing gemcitabine and chemotherapy alone, but no statistical differences in PFS (HR=0.63, 95% CI 0.30-1.32), OS (HR=0.72, 95 %CI 0.43-1.20), and adverse reactions (diarrhea: OR=0.75, 95%CI: 0.42-1.25; pernicious vomiting: OR=1.30, 95%CI: 0.82-2.06; leukopenia: OR=1.32, 95%CI: 0.88-1.98; thrombocytopenia: OR=1.05, 95%CI: 0.71-1.57; anemia: OR=1.18, 95%CI: 0.66-2.10; and hepatic impairment: OR=1.10. 95% CI: 0.63-1.92). CONCLUSION: 125I brachytherapy combined with the inclusion of gemcitabine chemotherapy enhance the clinical efficacy of patients with unresectable pancreatic neoplasm without increasing the incidence of adverse effects such as pancreatic fistula, pancreatitis, seed migration, and duodenitis compared with chemotherapy. However, there was no obvious effect on the survival of unresectable pancreatic neoplasm.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of 125I Seed Brachytherapy Combined with Gemcitabine Containing Chemotherapy for Unresectable Pancreatic Neoplasm—A Meta-Analysis

Yang¹,

Yang²,

Cong³

et al. 2022

JCMP

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“…Timmer et al reported the most interesting studies in this field applied to pancreatic cancer [ 66 ].…”

Section: Loco-regional Therapiesmentioning

confidence: 99%

Interventional Radiology in the Treatment of Pancreatic Adenocarcinoma: Present and Future Perspectives

Punzi

Carrubba

Contegiacomo

et al. 2023

Life

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Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease; patients’ long-term survival is strictly linked to the surgical resection of the tumor but only a minority of patients (2–3%) have a resectable disease at diagnosis. In patients with surgically unresectable disease, interventional radiology is taking on an increasing role in treatment with the application of loco-regional percutaneous therapies. The primary purposes of this narrative review are to analyze the safety and efficacy of ablative techniques in the management of borderline resectable and locally advanced diseases and to underline the role of the interventional radiologist in the management of patients with distant metastases. The secondary purpose is to focus on the synergy between immunotherapy and ablative therapies.

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“…Compared with other thermal ablation techniques, MWA can rapidly heat tissue and is insusceptible to the heat sink effect. [ 145 , 146 ] However, akin to RFA, MWA is usually used as a single treatment, accompanied with the postoperative tumor recurrence rate remaining high, and the prognosis is unsatisfactory. Therefore, it is necessary to develop new solutions to overcome these concerns.…”

Section: Clinical Physiotherapy‐activated or Combined Immunotherapymentioning

confidence: 99%

Rational Nanomedicine Design Enhances Clinically Physical Treatment‐Inspired or Combined Immunotherapy

et al. 2022

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Independent of tumor type and non‐invasive or minimally‐invasive feature, current physical treatments including ultrasound therapy, microwave ablation (MWA), and radiofrequency ablation (RFA) are widely used as the local treatment methods in clinics for directly killing tumors and activating systematic immune responses. However, the activated immune responses are inadequate and incompetent for tumor recession, and the incomplete thermal ablation even aggravates the immunosuppressive tumor microenvironment (ITM), resulting in the intractable tumor recurrence and metastasis. Intriguingly, nanomedicine provides a powerful platform as they can elevate energy utilization efficiency and augment oncolytic effects for mitigating ITM and potentiating the systematic immune responses. Especially after combining with clinical immunotherapy, the anti‐tumor killing effect by activating or enhancing the human anti‐tumor immune system is reached, enabling the effective prevention against tumor recurrence and metastasis. This review systematically introduces the cutting‐edge progress and direction of nanobiotechnologies and their corresponding nanomaterials. Moreover, the enhanced physical treatment efficiency against tumor progression, relapse, and metastasis via activating or potentiating the autologous immunity or combining with exogenous immunotherapeutic agents is exemplified, and their rationales are analyzed. This review offers general guidance or directions to enhance clinical physical treatment from the perspectives of immunity activation or magnification.

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Locally Advanced Pancreatic Cancer: Percutaneous Management Using Ablation, Brachytherapy, Intra-arterial Chemotherapy, and Intra-tumoral Immunotherapy

Cited by 14 publications

References 113 publications

Efficacy and Safety of 125I Seed Brachytherapy Combined with Gemcitabine Containing Chemotherapy for Unresectable Pancreatic Neoplasm—A Meta-Analysis

Efficacy and Safety of 125I Seed Brachytherapy Combined with Gemcitabine Containing Chemotherapy for Unresectable Pancreatic Neoplasm—A Meta-Analysis

Interventional Radiology in the Treatment of Pancreatic Adenocarcinoma: Present and Future Perspectives

Rational Nanomedicine Design Enhances Clinically Physical Treatment‐Inspired or Combined Immunotherapy

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