Palliative Care in Pancreatic Cancer

Brescia, Frank

doi:10.1177/107327480401100106

Cited by 19 publications

(12 citation statements)

References 44 publications

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“…The relief offered may enhance overall quality of life even when survival is limited. Most worrisome to patients and to their families is the aspect of pain, with 44% of patients experiencing severe pain 9. Most patients will require opioids around the clock.…”

Section: Discussionmentioning

confidence: 99%

Metastatic pancreatic cancer: abdominal pain in a 22-year-old woman

Roy¹,

Roy

2015

BMJ Case Reports

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Pancreatic cancer remains fourth among cancer-related deaths. Its diagnosis is often missed, owing to its vague abdominal symptoms, leading to a diagnosis of stage IV pancreatic cancer. FOLFIRINOX chemotherapy was administered to the patient in this report, resulting in significant improvement based on tests of biological markers as well as radiographic resolution of the metastatic disease. A keen awareness of this condition along with appropriate diagnostic tests can allow for an earlier diagnosis and may impact its high mortality.

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Section: Discussionmentioning

confidence: 99%

Metastatic pancreatic cancer: abdominal pain in a 22-year-old woman

Roy¹,

Roy

2015

BMJ Case Reports

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“…As most tissue properties are similar for these two materials, and the majority of pancreatic tumors arise in the head of the pancreas [6] which is near the duodenum, heating of the duodenum was modeled in this study. The effects of the distance from the applicator to the duodenum, the use of sectored transducers, and water-cooling of the duodenum on the peak temperatures generated in the duodenum were evaluated.…”

Section: Methodsmentioning

confidence: 99%

“…Although surgery provides the best chance for cure [2, 3], most cases have progressed to advanced or locally advanced disease by the time of diagnosis [4, 5], and over 80% of patients are not candidates for resection [2, 5]. For patients who are not surgical candidates, prolongation of survival and palliative relief of symptoms are the major goals of medical treatment [3, 4, 6], with chemotherapy and radiotherapy as the most common interventions [2, 4]. Palliative care for advanced disease may include surgery, radiotherapy, biliary stenting, gastroduodenal stenting, analgesia, celiac plexus blockage, and prophylactic anticoagulants to care for conditions such as pain, jaundice, gastrointestinal obstruction, and venous embolism [2, 4, 6].…”

Section: Introductionmentioning

confidence: 99%

“…For patients who are not surgical candidates, prolongation of survival and palliative relief of symptoms are the major goals of medical treatment [3, 4, 6], with chemotherapy and radiotherapy as the most common interventions [2, 4]. Palliative care for advanced disease may include surgery, radiotherapy, biliary stenting, gastroduodenal stenting, analgesia, celiac plexus blockage, and prophylactic anticoagulants to care for conditions such as pain, jaundice, gastrointestinal obstruction, and venous embolism [2, 4, 6]. Thermal ablation has been shown to cause a reduction in tumor volume, to lower pain, and in some studies, to prolong survival [5, 7, 8].…”

Section: Introductionmentioning

confidence: 99%

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Theoretical investigation of transgastric and intraductal approaches for ultrasound-based thermal therapy of the pancreas

et al. 2017

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BackgroundThe goal of this study was to theoretically investigate the feasibility of intraductal and transgastric approaches to ultrasound-based thermal therapy of pancreatic tumors, and to evaluate possible treatment strategies.MethodsThis study considered ultrasound applicators with 1.2 mm outer diameter tubular transducers, which are inserted into the tissue to be treated by an endoscopic approach, either via insertion through the gastric wall (transgastric) or within the pancreatic duct lumen (intraductal). 8 patient-specific, 3D, transient, biothermal and acoustic finite element models were generated to model hyperthermia (n = 2) and ablation (n = 6), using sectored (210°–270°, n = 4) and 360° (n = 4) transducers for treatment of 3.3–17.0 cm3 tumors in the head (n = 5), body (n = 2), and tail (n = 1) of the pancreas. A parametric study was performed to determine appropriate treatment parameters as a function of tissue attenuation, blood perfusion rates, and distance to sensitive anatomy.ResultsParametric studies indicated that pancreatic tumors up to 2.5 or 2.7 cm diameter can be ablated within 10 min with the transgastric and intraductal approaches, respectively. Patient-specific simulations demonstrated that 67.1–83.3% of the volumes of four sample 3.3–11.4 cm3 tumors could be ablated within 3–10 min using transgastric or intraductal approaches. 55.3–60.0% of the volume of a large 17.0 cm3 tumor could be ablated using multiple applicator positions within 20–30 min with either transgastric or intraductal approaches. 89.9–94.7% of the volume of two 4.4–11.4 cm3 tumors could be treated with intraductal hyperthermia. Sectored applicators are effective in directing acoustic output away from and preserving sensitive structures. When acoustic energy is directed towards sensitive structures, applicators should be placed at least 13.9–14.8 mm from major vessels like the aorta, 9.4–12.0 mm from other vessels, depending on the vessel size and flow rate, and 14 mm from the duodenum.ConclusionsThis study demonstrated the feasibility of generating shaped or conformal ablative or hyperthermic temperature distributions within pancreatic tumors using transgastric or intraductal ultrasound.

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“…The current standard clinical treatment for these patients involves gemcitabine-based chemotherapy with or without adjuvant radiation therapy, but these therapies have been shown to result in only modest survival and palliative benefit [2]. To relieve pain-related symptoms, which affects over 90% of advanced-staged patients, oral analgesics are typically administered; however, these require around-the-clock dosing for suitable palliation and have debilitating side effects, such as constipation [3,4]. Other current palliative techniques, such as alcohol ablation of the celiac plexus, have limited efficacy in some patients and may cause severe complications [4].…”

Section: Introductionmentioning

confidence: 99%

Thermal therapy of pancreatic tumours using endoluminal ultrasound: Parametric and patient-specific modelling

Adams

Scott

Salgaonkar

et al. 2016

International Journal of Hyperthermia

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Purpose To investigate endoluminal ultrasound applicator configurations for volumetric thermal ablation and hyperthermia of pancreatic tumors using 3D acoustic and biothermal finite element models. Materials and Methods Parametric studies compared endoluminal heating performance for varying applicator transducer configurations (planar, curvilinear-focused, or radial-diverging), frequencies (1–5 MHz), and anatomical conditions. Patient-specific pancreatic head and body tumor models were used to evaluate feasibility of generating hyperthermia and thermal ablation using an applicator positioned in the duodenal or stomach lumen. Temperature and thermal dose were calculated to define ablation (>240 EM43°C) and moderate hyperthermia (40–45 °C) boundaries, and to assess sparing of sensitive tissues. Proportional-integral control was incorporated to regulate maximum temperature to 70–80 °C for ablation and 45 °C for hyperthermia in target regions. Results Parametric studies indicated that 1–3 MHz planar transducers are most suitable for volumetric ablation, producing 5–8 cm3 lesion volumes for a stationary 5 minute sonication. Curvilinear-focused geometries produce more localized ablation to 20–45 mm depth from the GI tract and enhance thermal sparing (Tmax<42 °C) of the luminal wall. Patient anatomy simulations show feasibility in ablating 60.1–92.9% of head/body tumor volumes (4.3–37.2 cm3) with dose <15 EM43°C in the luminal wall for 18–48 min treatment durations, using 1–3 applicator placements in GI lumen. For hyperthermia, planar and radial-diverging transducers could maintain up to 8 cm3 and 15 cm3 of tissue, respectively, between 40–45 °C for a single applicator placement. Conclusions Modeling studies indicate the feasibility of endoluminal ultrasound for volumetric thermal ablation or hyperthermia treatment of pancreatic tumor tissue.

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Palliative Care in Pancreatic Cancer

Cited by 19 publications

References 44 publications

Metastatic pancreatic cancer: abdominal pain in a 22-year-old woman

Metastatic pancreatic cancer: abdominal pain in a 22-year-old woman

Theoretical investigation of transgastric and intraductal approaches for ultrasound-based thermal therapy of the pancreas

Thermal therapy of pancreatic tumours using endoluminal ultrasound: Parametric and patient-specific modelling

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