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

Saccomandi, Paola; Lapergola, Alfonso; Longo, Fabio; Schena, Emiliano; Quero, Giuseppe

doi:10.1080/02656736.2018.1506165

Cited by 70 publications

(55 citation statements)

References 112 publications

(256 reference statements)

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“…That may provide a clear puncture route on US imaging. (3) According to reported results of ablation of PC in recent 5 years, the ablation related mortality was 0-3% and morbidity was 3.5-28% [25]. All of our patients achieved safe therapies without any major complication even if by percutaneous approach, which may be attribute to careful indication selection, precise US guidance and fiber placement.…”

Section: Discussionsupporting

confidence: 50%

“…The American Joint Committee on Cancer (AJCC) staging system is the most widely used system to stage pancreatic cancer, which provides the basis for evaluating the resectability of the cancer and stratifying survival by stage [23] Majority of literatures reported the guidance approach of PC ablation were intra-operation and endosonography [25], which allowed a safer approach to target pancreatic lesions that located at deep retroperitoneal cavity. It is extremely difficult to reach PC clearly by a percutaneous approach by obtaining real-time imaging.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound–guided percutaneous laser ablation for pancreatic cancer: a new treatment option

Han

et al. 2020

Preprint

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Background & purpose‎: Most patients with pancreatic cancer (PC) suffer from an unresectable tumor at the time of diagnosis with limited treatment effectiveness. The purpose of this study is to investigate the feasibility and safety of percutaneous laser ablation (LA) for locally advanced and metastatic PC.Methods: Between September 2016 and April 2018, nine patients (mean age, 65.2 ± 5.4 years; age range, 62–68 years) with histologically proved PC were prospectively included to undergo ultrasound-guided LA. Effect including safety, pain perception and survival were evaluated. Results: Three patients were with locally advanced PC (stage III) and six with metastases (stage IV). All patients underwent LA in one session. The mean largest tumor diameter was ‎5.2±0.8 ‎cm (range, 4.2-6.9cm). Ablation power of all patients was 5 W and the mean ablation energy was 8.3±2.4 KJ (range 4.4-12KJ). Mean ablation volume was 17.1±3.2ml (range 13.0-22.1ml), which reached 89.1±7.4% (range 80.2-98.0%) of tumor volume. After a median follow-up period of 9.7 months (range, 6-15 months), the median survival from diagnosis was 11.2 months. Four stage IV patients died during 6.5-12.5 months after LA because of one hepatic encephalopathy and three tumor progression. No major complications occurred. Pain symptom achieved significant remission (P < 0.001) and patients experienced ameliorative physical function after LA. Percutaneous LA for unresectable PC is generally well tolerated. Conclusions: Preliminary results are encouraging with tumor size reducing and physical function significant improvement. US-guided percutaneous LA provides a new minimally invasive therapy modality for PC.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Ultrasound–guided percutaneous laser ablation for pancreatic cancer: a new treatment option

Han

et al. 2020

Preprint

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“…Radiofrequency ablation (RFA) results in thermal irreversible protein denaturation, cellular damage, and coagulative necrosis. Cryoablation results in in-situ freezing-related destruction of cellular ultra-structures and indirect actions such as vascular injury and apoptosis [4]. It has been reported to be safe and effective in solid tumors, including PDAC, possibly promoting an antitumor immune reaction [5,6].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background and study aims Endoscopic ultrasound (EUS)-guided ablation of pancreatic ductal adenocarcinoma (PDAC) with HybridTherm-Probe (EUS-HTP) is feasible and safe, but the radiological response and ideal tool to measure it have not been investigated yet. The aims of this study were to: 1) assess the radiological response to EUS-HTP evaluating the vital tumor volume reduction rate, Response Evaluation Criteria in Solid Tumors (RECIST1.1) and Choi criteria; 2) determine the prognostic predictive yield of these criteria. Patients and methods A retrospective analysis was performed of patients with locally advanced PDAC after primary treatment or unfit for chemotherapy prospectively treated by EUS-HTP. Computed tomography scan was performed 1 month after EUS-HTP to evaluate: 1) vital tumor volume reduction rate (VTVRR) by measuring necrosis and tumor volumes through a computer-aided detection system; and 2) RECIST1.1 and Choi criteria. Results EUS-HTP was feasible in 22 of 31 patients (71 %), with no severe adverse events. Median post-HTP survival was 7 months (1 – 35). Compared to pre-HTP tumor volume, a significant 1-month VTVRR (mean 21.4 %) was observed after EUS-HTP (P = 0.005). We identified through ROC analysis a VTVRR > 11.46 % as the best cut-off to determine post-HTP 6-month survival outcome (AUC = 0.733; sensitivity = 70.0 %, specificity = 83.3 %). This cut-off was significantly associated with longer overall survival (HR = 0.372; P = 0.039). According to RECIST1.1 and Choi criteria, good responders to EUS-HTP were 60 % and 46.7 %, respectively. Good responders according to Choi, but not to RECIST1.1, had longer survival (HR = 0.407; P = 0.04). Conclusions EUS-HTP induces a significant 1-month VTVRR. This effect is assessed accurately by evaluation of necrosis and tumor volumes. Use of VTVRR and Choi criteria, but not RECIST 1.1 criteria, might identify patients who could benefit clinically from EUS-HTP.

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“…This concept has been further explored to develop a probe for transurethral treatment of prostate cancer allowing full or focal gland ablation under MR-guidance [247]. The imaging [154,155,189,193,214] LI: Liver [50,70,82,83,101,145,146,159,163,193,196,[215][216][217][218][219] LU: Lung [87,88,99,114,138,144,157,169,190] PA: [86,93,95,137,158,185,[193][194][195] [150][151][152][153]191] Open circles represent explorative (small/few phase I/II) use and solid black circles represent many/large phase I/II trials, retrospective analyses or phase III evidence.…”

Section: Local Heating Techniquesmentioning

confidence: 99%

Heating technology for malignant tumors: a review

Kok

Cressman

Ceelen

et al. 2020

International Journal of Hyperthermia

263

206

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The therapeutic application of heat is very effective in cancer treatment. Both hyperthermia, i.e., heating to 39-45 C to induce sensitization to radiotherapy and chemotherapy, and thermal ablation, where temperatures beyond 50 C destroy tumor cells directly are frequently applied in the clinic. Achievement of an effective treatment requires high quality heating equipment, precise thermal dosimetry, and adequate quality assurance. Several types of devices, antennas and heating or power delivery systems have been proposed and developed in recent decades. These vary considerably in technique, heating depth, ability to focus, and in the size of the heating focus. Clinically used heating techniques involve electromagnetic and ultrasonic heating, hyperthermic perfusion and conductive heating. Depending on clinical objectives and available technology, thermal therapies can be subdivided into three broad categories: local, locoregional, or whole body heating. Clinically used local heating techniques include interstitial hyperthermia and ablation, high intensity focused ultrasound (HIFU), scanned focused ultrasound (SFUS), electroporation, nanoparticle heating, intraluminal heating and superficial heating. Locoregional heating techniques include phased array systems, capacitive systems and isolated perfusion. Whole body techniques focus on prevention of heat loss supplemented with energy deposition in the body, e.g., by infrared radiation. This review presents an overview of clinical hyperthermia and ablation devices used for local, locoregional, and whole body therapy. Proven and experimental clinical applications of thermal ablation and hyperthermia are listed. Methods for temperature measurement and the role of treatment planning to control treatments are discussed briefly, as well as future perspectives for heating technology for the treatment of tumors.

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

Cited by 70 publications

References 112 publications

Ultrasound–guided percutaneous laser ablation for pancreatic cancer: a new treatment option

Ultrasound–guided percutaneous laser ablation for pancreatic cancer: a new treatment option

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

Heating technology for malignant tumors: a review

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