EUS-Guided Antitumor Therapy for Pancreatic Tumors

Abstract

Endoscopic ultrasound (EUS) is a very useful modality for the diagnosis and staging of pancreatic masses. With the advent of EUS-guided fine-needle aspiration technology, this modality has made a tremendous leap from imaging modality to histologic diagnosis and therapeutic intervention. EUS offers high-resolution images of and unparalleled access to the pancreas. After locating the tip of the echoendoscope in the duodenum or stomach, several drugs or local treatment modalities can be delivered directly into the pancreas. EUS-guided ethanol lavage with/without paclitaxel injection has been tested for the treatment of cystic tumors of the pancreas, with complete resolution of cystic tumor being observed in up to 70-80% of patients. Ethanol injection is also performed for the management of solid neuroendocrine tumors of the pancreas. Various type of EUS-guided injection have also been investigated for the treatment of pancreatic cancer. An activated allogenic mixed lymphocyte culture (Cytoimplant) was injected in patients with advanced pancreatic cancer. A replication-deficient adenovirus vector carrying the tumor necrosis factor-alpha gene was also delivered intratumorally by EUS. ONYX-015 is an oncolytic attenuated adenovirus that exhibits replication preferentially in malignant cells, causing cell death, and this has also been injected into pancreatic cancers under EUS guidance. EUS-guided local ablation therapies such as radiofrequency ablation, photodynamic therapy, and brachytherapy are also under investigation. EUS-guided fine-needle injection for various solid or cystic lesions is a rapidly expanding field. This article reviews the various applications of EUS for the treatment of pancreatic tumors.

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

“…One early trial used concomitant immunotherapy with EUS-guided injection of OK-432, followed by intravenous infusion of lymphokine-activated killer cells stimulated with anti-CD3 monoclonal antibody. The investigators hypothesized that apoptotic cells induced by gemcitabine treatment could release tumor antigens slowly over time and that this stimulates dendritic cells to process and present tumor antigens [116]. The results were encouraging in five patients, but further studies are needed [117].…”

Echoendoscopic ablative therapy for solid pancreatic tumors

“…Although RFA is not likely to replace curative radical resection, local ablative therapy may be used as an adjunctive therapeutic modality in pancreatic cancer. RFA may reduce the tumor burden of pancreatic cancer and reinforce the efficacy of neoadjuvant chemoradiation therapy . The local application of RFA might change the pancreatic cancer microenvironment of desmoplasia that interferes with the delivery of chemotherapeutic agents .…”

Endoscopic Ultrasound in Gastroenteropancreatic Neuroendocrine Tumors

“…38 There have been multiple reports of ablation of insulinomas, leading to dramatic improvement of refractory hypoglycemic symptoms 39. Although EUS-FNI is still considered investigational, this technique may ultimately allow for a way to treat symptoms in a minimally invasive way in patients who are poor surgical candidates.…”