Feasibility of EUS-guided Nd:YAG laser ablation of unresectable pancreatic adenocarcinoma

Purpose: Pancreatic cancer is a challenging malignancy with low treatment option and poor life expectancy. Thermal ablation techniques were proposed as alternative treatment options, especially in advanced stages and for unfit-for-surgery patients. This systematic review describes the thermal ablative techniques-i.e., Laser (LA), Radiofrequency (RFA), Microwave (MWA) Ablation, High-Intensity Focused Ultrasound (HIFU) and cryoablation-available for pancreatic cancer treatment. Additionally, an analysis of the efficacy, complication rate and overall survival for each technique is conducted. Material and methods: This review collects the ex vivo, preclinical and clinical studies presenting the use of thermal techniques in the pancreatic cancer treatment, searched up to March 2018 in PubMed and Medline. Abstracts, letters-to-the-editor, expert opinions, reviews and non-English language manuscripts were excluded. Results: Sixty-five papers were included. For the ex vivo and preclinical studies, there are: 12 records for LA, 8 for RFA, 0 for MWA, 6 for HIFU, 1 for cryoablation and 3 for hybrid techniques. For clinical studies, 1 paper for LA, 14 for RFA, 1 for MWA, 17 for HIFU, 1 for cryoablation and 1 for hybrid techniques. Conclusions: Important technological advances are presented in ex vivo and preclinical studies, as the real-time thermometry, nanotechnology and hybrid techniques to enhance the thermal outcome. Conversely, a lack of standardization in the clinical employment of the procedures emerged, leading to contrasting results on the safety and feasibility of some analyzed techniques. Uniform conclusions on the safety and feasibility of these techniques for pancreatic cancer will require further structured investigation.

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“…Only one article was included in the analysis for a total of 9 patients [31]. All patients had a diagnosis of unresectable adenocarcinoma.…”

Section: Clinical Applicationmentioning

confidence: 99%

Thermal ablation of pancreatic cancer: A systematic literature review of clinical practice and pre-clinical studies

Saccomandi

Lapergola

Longo

et al. 2018

International Journal of Hyperthermia

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“…Recently, radiofrequency ablation (RFA), and microwave ablation (MWA) are the most common hyperthermia-based techniques deployed in the clinical application [32,33]. However, tumors located nearby large blood vessels can be quite difficult to be completely treated by RFA due to heat-sink effect [32].…”

Section: Discussionmentioning

confidence: 99%

“…In this model, a 1470-nm wavelength (spot size = 1.2 cm) was selected to facilitate temperature elevation in tissue due to high light absorption [30]. Accordingly, further application of linear energy modulation could avoid superficial carbonization as well as rapidly achieve the predetermined degree of coagulation in the tissue, which may implicate the feasible treatment of small-sized tumors such as pancreatic adenocarcinoma [33]. Nevertheless, other wavelength lasers should be conducted to investigate the scattering-dominated effects in various tissues and to confirm the versatility of the proposed linear-modulated hyperthermia treatment in terms of temperature development and thermal penetration depth.…”

Section: Discussionmentioning

confidence: 99%

Computational analysis of linear energy modulation for laser thermal coagulation

Tran

Truong

Jeong

et al. 2018

Biomed. Opt. Express

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Accurate treatment planning and monitoring are critical factors to ensure safe and effective outcomes of laser thermal coagulation (LTC). Computational and experimental models based upon linear energy modulation were deployed to predict temperature distribution and thermal damage within porcine liver. 1470-nm Gaussian emission was confirmed by using digital imaging and the customized goniometry. The tissue temperature was maintained in the pre-determined range (65~75 °C) to induce thermally destructive volumes of 0.23 cm (simulation) and 0.17 ± 0.05 cm (experiment) once the applied power was linearly reduced from 3.5 W to 0.2 W in 50 s ("3.5 W fast slope" laser modulation mode). The proposed model may be a useful tool to predict thermal responses of the tissue during LTC.

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“…The duration of the laser discharge was 5 min, in such a way as to release 600 J of energy for each trial. This energy setting is typical of clinical applications of laser ablation for tumor treatment [29].…”

Section: A Laser Instrumentationmentioning

confidence: 99%

Fiber Optic Sensors-Based Thermal Analysis of Perfusion-Mediated Tissue Cooling in Liver Undergoing Laser Ablation

Vita

Landro

Massaroni

et al. 2021

IEEE Trans. Biomed. Eng.

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The current challenge in the field of thermo-ablative treatments of tumors is to achieve a balance between complete destruction of malignant cells and safeguarding of the surrounding healthy tissue. Blood perfusion plays a key role for thermal ablation success, especially in the case of highly vascularized organs like liver. This work aims at monitoring the temperature within perfused swine liver undergoing laser ablation (LA). Temperature was measured through seven arrays of Fiber Bragg Grating sensors (FBGs) around the laser applicator. To mimic reality, blood perfusion within the ex-vivo liver was simulated using artificial vessels. The influence of blood perfusion on LA was carried out by comparing the temperature profiles in two different spatial configurations of vessels and fibers. The proposed setup permitted to accurately measure the heat propagation in real-time with a temperature resolution of 0.1 °C and to observe a relevant tissue cooling near to the vessel up to 65%.

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Feasibility of EUS-guided Nd:YAG laser ablation of unresectable pancreatic adenocarcinoma

Cited by 73 publications

References 25 publications

Thermal ablation of pancreatic cancer: A systematic literature review of clinical practice and pre-clinical studies

Thermal ablation of pancreatic cancer: A systematic literature review of clinical practice and pre-clinical studies

Computational analysis of linear energy modulation for laser thermal coagulation

Fiber Optic Sensors-Based Thermal Analysis of Perfusion-Mediated Tissue Cooling in Liver Undergoing Laser Ablation

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