Percutaneous ablation of pancreatic cancer

Abstract

Pancreatic ductal adenocarcinoma is a highly aggressive tumor with an overall 5-year survival rate of less than 5%. Prognosis and treatment depend on whether the tumor is resectable or not, which mostly depends on how quickly the diagnosis is made. Chemotherapy and radiotherapy can be both used in cases of non-resectable pancreatic cancer. In cases of pancreatic neoplasm that is locally advanced, non-resectable, but non-metastatic, it is possible to apply percutaneous treatments that are able to induce tumor cytoreduction. The aim of this article will be to describe the multiple currently available treatment techniques (radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation), their results, and their possible complications, with the aid of a literature review.

Pancreatic Ultrasound: State of the Art

“…Nowadays, percutaneous ablation can be considered, along with chemotherapy, in a multimodal therapeutic approach to unresectable pancreatic adenocarcinoma that is locally advanced and without metastases, tailoring the combined therapeutic plan to each different patient. The treatments are associated with palliative therapeutic effects due to necrosis, cytolysis, and cell death creation, with a resulting neoplastic mass cytoreduction …”

“…The treatments are associated with palliative therapeutic effects due to necrosis, cytolysis, and cell death creation, with a resulting neoplastic mass cytoreduction. [86][87][88] In cases of drainage positioning, the anechoic aspect of fluid within the collection gives ideal conditions to better visualize the catheter during its positioning. Shorter and more direct access to the pancreas is preferred, avoiding adjacent structure involvement.…”

EUS-guided Radiofrequency Ablation (EUS-RFA) of Solid Pancreatic Neoplasm Using an 18-gauge Needle Electrode: Feasibility, Safety, and Technical Success

“…This should result in longer applications of radiofrequency energy (on average, 50 s/application), which could reduce the number of applications (in our series, 1.5 on average), and avoid the need to relocate the electrode several times inside the tumor. This technique is based on the so-called "thermal diffusivity effect" [3], which is related to thermal neoplastic conductibility: heat spreads inside the neoplastic mass, and not outside of it, making the procedure safer. Moreover, the slower thermal diffusion, which can be visualized real-time during EUS, should make the procedure easier to control for endosonographers.…”

“…In this setting, combining multimodality therapies might improve the treatment outcome [2]. Radiofrequency ablation (RFA) produces a thermalinduced coagulative necrosis of the tumor [3]. Some studies demonstrate that thermal ablation can induce an immune response towards the tumor, determined by the release of necrotic cell content in the extracellular space that stimulate the host's antitumor immunity [4].…”

High‐resolution intravascular MRI‐guided perivascular ultrasound ablation

“…Two common types of palliative or potentially curative treatments undergoing clinical trials are percutaneous ablation and extracorporeal high‐intensity focused ultrasound (HIFU) . Currently, percutaneous ablations include thermal ablation methods, such as radiofrequency (RF) ablation (RFA), microwave ablation, laser ablation and cryoablation, and nonthermal ablation, such as irreversible electroporation and photodynamic therapy.…”