Ultrasound Ablation in Advanced Pancreatic Cancer Patients – What should be the Next Step?

Abstract

In the last decades the treatment for many diseases has changed dramatically. Open surgery procedures with high morbidity and complication rates, suboptimal clinical results based on large impairment for the patients were replaced by drug treatment or minimally invasive techniques. Examples such as interventional cardiology procedures in acute myocardial infarction, interventional endoscopies in the treatment of hepato-biliary tract diseases, eradication of Helicobacter pylori for gastric ulcer using drugs are good evidence that the words of William Osler "Diseases that harm require therapies that harm less" are valid now-a-days. 1Pancreatic Cancer (PC) is one of the most aggressive malignant diseases which survival rate, clinical results and treatment has not improved substantially in the past 40 years. Radical surgery is still the only curative method for pancreatic cancer in early stage. Estimated, only 20% of all cases with PC in early stage are suitable for surgical resection at the time of diagnosis, still the expected 5-year survival rate remains 5-20%. The other 80% of cases with advanced PC (including locally and systemically advanced pancreatic cancer) have an expected median survival time of only a few months and almost 0% of 5 year-survival rate when effective alternative treatment methods are missing. 2,3 In those patients with unresectable advanced pancreatic cancer, there is still an urgent need for effective therapies that should not only achieve sufficient local tumor control but also improve local symptoms and quality of life as well as alleviate tumor-associated pain.

Local Ablative Therapy Options for Patients with Inoperable Pancreatic Cancer

“…With regard to symptom scores, IRE did not improve patients' complaints. This is in contradiction to several other studies reporting local ablative therapy options for advanced pancreatic cancer, like high-intensity focused ultrasound (HIFU) (2)(3)(4). No severe complications (eg, lesion bleeding, gastrointestinal tract bleeding or gastrointestinal perforation) were observed with HIFU in 224 Chinese patients (5).…”

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

“…OS for patients treated with MWA depends on the type of cancer. 38 , 39 , 58 MWA has similar minor complications as with RFA, 35 and may have similar or better outcomes in specific clinical settings such as larger solitary liver lesions <5 cm in diameter.…”