Clinical effectiveness of combined interventional therapy as a salvage modality for unresectable pancreatic carcinoma

Abstract

Although different treatment methods have been introduced to treat advanced pancreatic carcinoma, the median overall survival rate remains unsatisfactory. Theoretically, combining different treatment methods should work in synergy to enhance locoregional disease control and improve survival. Therefore, the aim of the present retrospective study was to analyze the effectiveness of combined interventional therapy compared with trans-arterial chemoembolization (TACE) or chemotherapy alone for the treatment of unresectable pancreatic carcinoma. A total of 266 patients who were undergoing treatment for unresectable pancreatic carcinoma between July 2012 and November 2015 were included in the current study. The tumor responses and 3-year overall survival rates of patients treated with combined interventional therapy (TACE combined with iodine-125 seed implantation and/or radiofrequency ablation; CIT group; n=84) were compared with those of patients treated with TACE alone (TACE group; n=59), as well as patients treated with systemic chemotherapy alone (control group; n=123). Patients in the CIT group exhibited significantly improved tumor responses compared with patients in the TACE group (51.89 vs. 30.61%; P=0.028) or control group (51.89 vs. 17.20%; P<0.001). The 3-year overall survival rate of the CIT group was also significantly higher compared with that of the TACE and control groups (P=0.0116 and P=0.0001, respectively). Furthermore, the CIT group exhibited a significantly higher overall survival rate for patients with unresectable metastatic pancreatic cancer compared with the TACE and control groups (P=0.0088 and P<0.0001, respectively), which suggests that a combination of different interventional techniques increases the survival of patients with unresectable pancreatic cancer. No life-threatening complications were observed in any treatment group. In conclusion, combined interventional therapy exhibits a good efficacy and an improved survival rate for unresectable pancreatic cancer compared with TACE alone.

Locoregional Treatment of Metastatic Pancreatic Cancer Utilizing Resection, Ablation and Embolization: A Systematic Review

“…Seven articles reported findings on LDT utilizing TACE in metastatic pancreatic cancer ( Table 6 ) [ 43 , 44 , 48 , 75 , 76 , 77 , 78 ]. A total of 549 of mPDAC patients were included (416 with liver-only, 109 with liver and EHD, and 24 liver with or without EHD).…”

“…Patients with oligometastatic PDAC (primarily) spread to the liver or lungs who received both radical-intent local primary and local metastatic treatment (liver 7.8–19 months; lungs 22.8–47 months) had superior survival outcomes from metastatic diagnosis or treatment compared to those receiving chemo(radio)therapy (CRT) or best supportive care (BSC) (liver 4.3–7.6 months; lungs 11.8 months) ( Table 7 ) [ 26 , 27 , 50 , 52 , 57 , 66 , 78 ]. For hepatic mPDAC, neither exclusive local primary (9.1–9.2 months) nor sole local metastatic (7.5 months) treatment seems beneficial when compared to the CRT or BSC survival outcomes.…”

Recent nanotechnology advancements to treat multidrug-resistance pancreatic cancer: Pre-clinical and clinical overview

“…Category Prevalence Mutations cancer are other approaches that have been studied retrospectively and TACE combined with either 125 I seed implantation and/or RFA, was shown to have improved treatment response and overall survival rate compared with TACE alone (Das et al, 2019). However, in the same study, the overall survival rates were better in the case of RFA.…”

“…The stromal barrier created by PSC elevates the interstitial fluid pressure and compresses the blood vessels, preventing passive transportation of chemotherapeutic agents and eventually leading to treatment failure ( Erkan et al, 2012 ; Hackeng et al, 2016 ). Efficacy of Trans-arterial chemoembolization (TACE) with TACE + radiofrequency ablation (RFA) and/or 125 I radioactive seed implantation for unresectable pancreatic cancer are other approaches that have been studied retrospectively and TACE combined with either 125 I seed implantation and/or RFA, was shown to have improved treatment response and overall survival rate compared with TACE alone ( Das et al, 2019 ). However, in the same study, the overall survival rates were better in the case of RFA.…”

Current status of non-surgical treatment of locally advanced pancreatic cancer

“…Over the past years, alongside with systemic chemotherapy and radiotherapy (RT), minimally invasive image-guided procedures have emerged for the management of non-operable or recurrent locally advanced PC. These include ablative modalities such as radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation, cryoablation (CA), reversible electrochemotherapy (ECT) and irreversible electroporation (IRE), and high intensity focused ultrasound, while trans-arterial embolization procedures have also been suggested and investigated[ 10 - 12 ]. Following the initially non-satisfactory results, which were correlated with unacceptable complication rates, outcomes of minimally-invasive image-guided procedures were significantly improved, mainly due to the cumulative experience, and technological advances of the devices used, and their incorporation in the treatment algorithm for PC has been gradually accepted in specialized centers[ 10 ].…”