CardioVascular and Interventional Radiology

, Volume 37, Issue 3, pp 586–591 | Cite as

Minimally Invasive Ablation Treatment for Locally Advanced Pancreatic Adenocarcinoma

  • Michele Rossi
  • Gianluigi Orgera
  • Adam Hatzidakis
  • Miltiadis Krokidis


Pancreatic adenocarcinoma is an aggressive tumour with an extremely poor prognosis, which has not changed significantly during the last 30 years. Prolonged survival is achieved only by R0 resection with macroscopic tumour clearance. However, the majority of the cases are considered inoperable at diagnosis due to local spread or presence of metastatic disease. Chemoradiotherapy is not tolerated by all patients and still fails to prolong survival significantly; neoadjuvant treatment also has limited results on pain control or tumour downstaging. In recent years, there has been a growing interest in the use of ablation therapy for the treatment of nonresectable tumours in various organs. Ablation techniques are based on direct application of chemical, thermal, or electrical energy to a tumour, which leads to cellular necrosis. With ablation, tumour cytoreduction, local control, and relief from symptoms are obtained in the majority of the patients. Inoperable cases of pancreatic adenocarcinoma have been treated by various ablation techniques in the last few years with promising results. The purpose of this review is to present the current status of local ablative therapies in the treatment of pancreatic adenocarcinoma and to investigate on the efficiency and the future trends.


Pancreatic cancer Ablation Loco-regional treatment Interventional oncology 


Conflict of interest

All authors have no conflict of interest to disclose.


  1. 1.
    Spinelli GP, Zullo A, Romiti A, Di Seri M, Tomao F, Miele E et al (2006) Long-term survival in metastatic pancreatic cancer. A case report and review of the literature. JOP 7:486–491PubMedGoogle Scholar
  2. 2.
    Jemal A, Thomas A, Murray T, Thun M (2002) Cancer statistics, 2002. CA Cancer J Clin 52:23–47PubMedCrossRefGoogle Scholar
  3. 3.
    Callery MP, Chang KJ, Fishman EK, Talamonti MS, William Traverso L et al (2009) Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol 16:1727–1733PubMedCrossRefGoogle Scholar
  4. 4.
    Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H et al (2006) Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 13:1035–1046PubMedCrossRefGoogle Scholar
  5. 5.
    Ghaneh P, Kawesha A, Howes N, Jones L, Neoptolemos JP (1999) Adjuvant therapy for pancreatic cancer. World J Surg 23:937–945PubMedCrossRefGoogle Scholar
  6. 6.
    Hu J, Zhao G, Wang HX, Tang L, Xu YC, Ma Y et al (2011) A meta-analysis of gemcitabine containing chemotherapy for locally advanced and metastatic pancreatic adenocarcinoma. J Hematol Oncol 4:1–15CrossRefGoogle Scholar
  7. 7.
    Loehrer PJ Sr, Feng Y, Cardenes H, Wagner L, Brell JM, Cella D et al (2011) Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group Trial. J Clin Oncol 29:4105–4112PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, et al., Groupe Tumeurs Digestives of Unicancer, PRODIGE Intergroup, Groupe Tumeurs Digestives of Unicancer, PRODIGE Intergroup (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364:1817–1825Google Scholar
  9. 9.
    Loehrer PJ Sr, Feng Y, Cardenes H, Wagner L, Brell JM, Cella D et al (2011) Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group Trial. J Clin Oncol 29:4105–4112PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Huguet F, André T, Hammel P, Artru P, Balosso J, Selle F et al (2007) Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol 25:326–331PubMedCrossRefGoogle Scholar
  11. 11.
    Jurgensen C, Schuppan D, Neser F, Ernstberger J, Junghans U, Stolzel U (2006) EUS-guided alcohol ablation of an insulinoma. Gastrointest Endosc 63:1059–1062PubMedCrossRefGoogle Scholar
  12. 12.
    Goel R, Anderson K, Slaton J, Schmidlin F, Vercellotti G, Belcher J et al (2009) Adjuvant approaches to enhance cryosurgery. J Biomech Eng 131(7):074003PubMedCrossRefGoogle Scholar
  13. 13.
    Robinson D, Halperin N, Nevo Z (2001) Two freezing cycles ensure interface sterilization by cryosurgery during bone tumor resection. Cryobiology 43:4–10PubMedCrossRefGoogle Scholar
  14. 14.
    Habash RW, Bansal R, Krewski D, Alhafid HT (2007) Thermal therapy, part III: ablation techniques. Crit Rev Biomed Eng 35(1–2):37–121PubMedCrossRefGoogle Scholar
  15. 15.
    Goldberg SN, Mallery S, Gazelle GS, Brugge WR (1999) EUS-guided radiofrequency ablation in the pancreas: results in a porcine model. Gastrointest Endosc 50:392–401PubMedCrossRefGoogle Scholar
  16. 16.
    Date RS, Biggins J, Paterson I, Denton J, McMahon RF, Siriwardena AK (2005) Development and validation of an experimental model for the assessment of radiofrequency ablation of pancreatic parenchyma. Pancreas 30:266–271PubMedCrossRefGoogle Scholar
  17. 17.
    Matsui Y, Nakagawa A, Kamiyama Y, Yamamoto K, Kubo N, Nakase Y (2000) Selective thermocoagulation of unresectable pancreatic cancers by using radiofrequency capacitive heating. Pancreas 20:14–20PubMedCrossRefGoogle Scholar
  18. 18.
    Fegrachi S, Besselink MG, van Santvoort HC, van Hillegersberg R, Molenaar IQ (2013) Radiofrequency ablation for unresectable locally advanced pancreatic cancer: a systematic review. HPB (Oxford). doi: 10.1111/hpb.12097 Google Scholar
  19. 19.
    Girelli R, Frigerio I, Salvia R, Barbi E, Tinazzi Martini P, Bassi C (2010) Feasibility and safety of radiofrequency ablation for locally advanced pancreatic cancer. Br J Surg 97:220–225PubMedCrossRefGoogle Scholar
  20. 20.
    Spiliotis JD, Datsis AC, Michalopoulos MV, Kekelos SP, Vaxevanidou A, Rogdakis AV et al (2007) Radiofrequency ablation combined with palliative surgery may prolong survival of patients with advanced cancer of the pancreas. Langenbecks Arch Surg 392:55–60PubMedCrossRefGoogle Scholar
  21. 21.
    Singh V, Varshney S, Sewkani A, Varshney R, Deshpande G, ShajiPJat A (2001) Radiofrequency ablation of unresectable pancreatic carcinoma: 10-year experience from single centre. Pancreatology 11(Suppl 1):52Google Scholar
  22. 22.
    Wu Y, Tang Z, Fang H, Gao S, Chen J, Wang Y et al (2006) High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer. J Surg Oncol 94:392–395PubMedCrossRefGoogle Scholar
  23. 23.
    Fegrachi S, Molenaar IQ, Klaessens JH, Besselink MG, Offerhaus JA, van Hillegersberg R (2013) Radiofrequency ablation of the pancreas with and without intraluminal duodenal cooling in a porcine model. J Surg Res. doi: 10.1016/j.jss.2013.04.068 PubMedGoogle Scholar
  24. 24.
    Cavallini M, La Torre M, Citone M, Rossi M, Rebonato A, Nava AK et al (2010) A novel approach in surgical palliation for unresectable pancreatic cancer with untreatable chronic pain: Radiofrequency ablation of pancreatic mass and celiac plexus. Am Surg 76(8):E108–E109PubMedGoogle Scholar
  25. 25.
    Lubner MG, Brace CL, Hinshaw JL, Lee FT Jr (2010) Microwave tumor ablation: mechanism of action, clinical results, and devices. J Vasc Interv Radiol 21(8 Suppl):S192–S203PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Simon CJ, Dupuy DE, Mayo-Smith WW (2005) Microwave ablation: principles and applications. Radiographics 25:S69–S83PubMedCrossRefGoogle Scholar
  27. 27.
    Wright SA, Lee FT, Mahvi DM (2003) Hepatic microwave ablation with multiple antennae results in synergistically larger zones of coagulation necrosis. Ann Surg Oncol 10:275–283PubMedCrossRefGoogle Scholar
  28. 28.
    Shock SA, Meredith K, Warner TF (2004) Microwave ablation with loop antenna: in vivo porcine liver model. Radiology 231:143–149PubMedCrossRefGoogle Scholar
  29. 29.
    Lygidakis NJ, Sharma SK, Papastratis P, Zivanovic V, Kefalourous H, Koshariya M et al (2007) Microwave ablation in locally advanced pancreatic carcinoma—a new look. Hepatogastroenterology 54(77):1305–1310PubMedGoogle Scholar
  30. 30.
    Carrafiello G, Ierardi AM, Piacentino F, Lucchina N, Dionigi G, Cuffari S et al (2012) Microwave ablation with percutaneous approach for the treatment of pancreatic adenocarcinoma. Cardiovasc Interv Radiol 35:439–442CrossRefGoogle Scholar
  31. 31.
    Dubinsky TJ, Cuevas C, Dighe MK (2008) High-intensity focused ultrasound: current potential and oncologic applications. AJR Am J Roentgenol 190:191–199PubMedCrossRefGoogle Scholar
  32. 32.
    He SX, Wang GM (2002) The noninvasive treatment of 251 cases of advanced pancreatic cancer with focused ultrasound surgery. In: Andrew MA, Crum LA, Vaezy S (eds) Proceedings from the 2nd international symposium on therapeutic ultrasound. University of Washington, Seattle, pp 51–56Google Scholar
  33. 33.
    Wu F, Chen WZ, Bai J, Zou JZ, Wang ZL, Zhu H et al (2001) Pathological changes in human malignant carcinoma treated with high-intensity focused ultrasound. Ultrasound Med Biol 27:1099–1106PubMedCrossRefGoogle Scholar
  34. 34.
    Yuan C, Yang L, Yao C (2003) Observation of high intensity focused ultrasound treating 40 cases of pancreatic cancer [in Chinese]. Chin J Clin Hepatol 19:145–146Google Scholar
  35. 35.
    Orgera G, Krokidis M, Monfardini L, Arnone P, Bonomo G, Della Vigna P et al (2012) Ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation in pancreatic metastasis from renal cell carcinoma. Cardiovasc Intervent Radiol 35(5):1258–1261PubMedCrossRefGoogle Scholar
  36. 36.
    Orgera G, Monfardini L, Della Vigna P, Zhang L, Bonomo G, Arnone P et al (2011) High-intensity focused ultrasound (HIFU) in patients with solid malignancies: evaluation of feasibility, local tumour response and clinical results. Radiol Med 116(5):734–748PubMedCrossRefGoogle Scholar
  37. 37.
    Orgera G, Krokidis M, Monfardini L, Bonomo G, Della Vigna P, Fazio N et al (2011) High intensity focused ultrasound ablation of pancreatic neuroendocrine tumours: report of two cases. Cardiovasc Intervent Radiol 34(2):419–423PubMedCrossRefGoogle Scholar
  38. 38.
    OrgeraG, Della Vigna P, Bonomo G, Monfardini L, Curigliano G, Orsi F (2010) High-intensity focused ultrasound treatment in patients with advanced pancreatic cancer: assessment of local tumor response and clinical results. Original scientific research (abstract no. 303). Society of interventional radiology 35th annual scientific meeting, Tampa, FL, USAGoogle Scholar
  39. 39.
    Granot Y, Rubinsky B (2008) Mass transfer model for drug delivery in tissue cells with reversible electroporation. Int J Heat Mass Transf 51:5610–5616PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Escobar-Chavez JJ, Bonilla-Martinez D, Villegas-Gonzalez MA, Revilla-Vázquez AL (2009) Electroporation as an efficient physical enhancer for skin drug delivery. J Clin Pharmacol 49:1262–1283PubMedCrossRefGoogle Scholar
  41. 41.
    Prud’homme GJ, Glinka Y, Khan AS, Draghia-Akli R (2006) Electroporation enhanced nonviral gene transfer for the prevention or treatment of immunological, endocrine and neoplastic diseases. Curr Gene Ther 6:243–273PubMedCrossRefGoogle Scholar
  42. 42.
    Lee RC (2005) Cell injury by electric forces. Ann N Y Acad Sci 1066:85–91PubMedCrossRefGoogle Scholar
  43. 43.
    Davalos RV, Mir IL, Rubinsky B (2005) Tissue ablation with irreversible electroporation. Ann Biomed Eng 33:223–231PubMedCrossRefGoogle Scholar
  44. 44.
    Rubinsky B, Onik G, Mikus P (2007) Irreversible electroporation: a new ablation modality—clinical implications. Technol Cancer Res Treat 6:37–48PubMedGoogle Scholar
  45. 45.
    Edd JF, Horowitz L, Davalos RV, Mir LM, Rubinsky B (2006) In vivo results of a new focal tissue ablation technique: irreversible electroporation. IEEE Trans Biomed Eng 53:1409–1415PubMedCrossRefGoogle Scholar
  46. 46.
    Maor E, Ivorra A, Leor J, Rubinsky B (2007) The effect of irreversible electroporation on blood vessels. Technol Cancer Res Treat 6:307–312PubMedGoogle Scholar
  47. 47.
    Bower M, Sherwood L, Li Y, Martin R (2011) Irreversible electroporation of the pancreas: definitive local therapy without systemic effects. J Surg Oncol 104:22–28PubMedCrossRefGoogle Scholar
  48. 48.
    Martin RC 2nd, McFarland K, Ellis S, Velanovich V (2012) Irreversible electroporation in locally advanced pancreatic cancer: potential improved overall survival. Ann Surg Oncol. doi: 10.1245/s10434-012-2736-1 Google Scholar
  49. 49.
    Narayanan G, Hosein P, Arora G, Barbery K, Froud T, Livingstone A et al (2012) Percutaneous irreversible electroporation for down staging and control of unresectable pancreatic adenocarcinoma. J Vasc Interv Radiol 23:1613–1621PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2013

Authors and Affiliations

  • Michele Rossi
    • 1
  • Gianluigi Orgera
    • 1
  • Adam Hatzidakis
    • 2
  • Miltiadis Krokidis
    • 3
  1. 1.Unit of Interventional RadiologyS. Andrea University Hospital “Sapienza”RomeItaly
  2. 2.Department of Radiology, Medical School of CreteUniversity Hospital of HeraklionHeraklionGreece
  3. 3.Department of RadiologyCambridge University Hospitals NHS TrustCambridgeUK

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