Palliative therapy in pancreatic cancer—interventional treatment with radiofrequency ablation/irreversible electroporation

Abstract

Pancreatic cancer (PC) is a solid tumor with still a dismal prognosis. Diagnosis is usually late, when the disease is metastatic or locally advanced (LAPC). Only 20% of PC are amenable to surgery at the time of diagnosis and the vast majority of them, despite radically resected will unavoidably recur. The treatment of LAPC is a challenge. Current guidelines suggest to adopt systemic therapies upfront, based on multi-drugs chemotherapy regimens. However, the vast majority of patients will never experience conversion to surgical exploration and radical resection. Thus, there a large subgroup of LAPC patients where the only therapeutic chance is to offer palliative treatments, such as interventional ablative treatments, in order to obtain a cytoreduction of the tumor, trying to delay its growth and spread. Radiofrequency ablation (RFA) and irreversible electroporation (IRE) demonstrated to be safe and effective in obtaining a local control of the disease with some promising oncological results in terms of overall survival (OS). However, they should be adopted as a treatment strategy to adopt in parallel with other systemic therapies, within multidisciplinary choices. They are not free from complications, even serious, thus they should applied only in specialized centers of pancreatology. This review depicts the state of the art of the two techniques.

Necrosis volume and Choi criteria predict the response to endoscopic ultrasonography-guided HybridTherm ablation of locally advanced pancreatic cancer

“…In other patients with biliary stents, EUS-HTP was safe and successful (85.7 %). This may be due to the heat sink effect 30 31 32 33 or to the HTP cooling system preventing thermal injury to the surrounding vascular structures and organs, or due to an EUS approach that enables precise targeting of pancreatic tumor with minimal invasivity and procedure monitoring in real time 34 35 .…”

Irreversible Electroporation: Background, Theory, and Review of Recent Developments in Clinical Oncology

“…In recent years, IRE has been associated with overall survival of up to 27 months for patients with unresectable LAPC, 86 and response rates commonly exceed 70%. [87][88][89] In addition to potential survival improvements, some patients have been able to lower narcotic intake 83 after treatment and others have shown major improvements in QoL. 89 Depending on the extent of vascular involvement, downstaging occurs in 5-10% of cases, allowing for follow-up resection.…”

Starting a Fire Without Flame: The Induction of Cell Death and Inflammation in Electroporation-Based Tumor Ablation Strategies

“…New treatment paradigms are direly needed. Minimally invasive tumor ablation treatments such as cryotherapy, laser irradiation, microwave irradiation, radiofrequency ablation, high-intensity focused ultrasound ablation, and irreversible electroporation (IRE), have shown significant promise (2,3). Ablation modalities function through the direct or indirect induction of cell death, resulting in the destruction of tissue by thermal, mechanical, or electrical means.…”