Role of radio‑ablative technique for optimizing the survival of patients with locally advanced pancreatic adenocarcinoma (Review)

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is one of the most common and frequently diagnosed malignant tumor of the pancreas with few treatment options and poor life expectancy. Despite the advances in the surgical field, 40% of the patients are diagnosed with locally advanced disease which is not suitable for surgery. Radio-frequency ablation (RFA) has been described as a new 'weapon' in the multimodal treatment of PDAC, representing a cytoreductive procedure which must be completed with radiotherapy or chemo-radiotherapy. A systematic research was carried out utilizing the PubMed database in regards to this subject, to evaluate the role of RFA in PDAC management. Abstracts, letters-to-the-editor and non-English language manuscripts were excluded. The literature showed that RFA can be used in open and laparoscopic surgery but it is also feasible for endoscopic ultrasound (EUS-guided RFA) or percutaneous approach. Even though we found optimistic and encouraging reports on overall survival (OS), randomized studies are still required to corroborate these findings. Our review research underline that surgical resection remains the only radical treatment option, RFA being a safe and feasible technique reserved for unresectable, non-metastatic pancreatic tumors.Its combination with oncological treatment can improve the OS of these patients.

Simultaneous Gemcitabine and Percutaneous CT-Guided Irreversible Electroporation for Locally Advanced Pancreatic Cancer

“…At present, minimally invasive treatments such as radiofrequency, microwave, and cryoablation have been demonstrated to be effective for LAPC patients [ 6 – 8 ]. These types of technology, however, have the potential to damage bile ducts, pancreatic ducts, peripancreatic vessels, and the duodenum, which may result in limited benefit [ 9 , 10 ].…”

Locoregional Thermal and Chemical Tumor Ablation: Review of Clinical Applications and Potential Opportunities for Use in Low- and Middle-Income Countries

“…16 - 18 Hyperthermic damage to cellular membranes and subcellular structures causes cell membrane dysfunction and protein denaturation, leading to cell death via acute coagulative necrosis. 19 , 20 Typically, 5-250 W of power is generated to obtain and maintain ablation temperatures for 10 seconds, up to 30 minutes, for a treatment section. 21 - 24 Ablation temperatures near 100°C from 12 to 30 minutes are typically achieved to avoid carbonization, charring, or vaporization, which can limit thermal conduction required for larger RFA treatment zones.…”