La radiologia medica

, Volume 119, Issue 7, pp 483–498 | Cite as

Systematic review of minimally invasive ablation treatment for locally advanced pancreatic cancer

  • Anna Maria Ierardi
  • Natalie Lucchina
  • Mario Petrillo
  • Chiara Floridi
  • Filippo Piacentino
  • Alessandro Bacuzzi
  • Paolo Fonio
  • Federico Fontana
  • Carlo Fugazzola
  • Luca Brunese
  • Gianpaolo Carrafiello
Vascular And Interventional Radiology


Unresectable locally advanced pancreatic cancer with or without metastatic disease is associated with a very poor prognosis. Ablation techniques are based on direct application of chemical, thermal, or electrical energy to a tumor, which leads to cellular necrosis. Initial studies about ablation therapies of the pancreas were associated with significant morbidity and mortality, which limited widespread adoption. Modifications to the various applications, in particular combining the techniques with high-quality imaging and intra-operative approach has enabled real-time treatment monitoring and significant improvements in safety. Inoperable cases of pancreatic cancer 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 advanced tumor.


Pancreatic cancer Radiofrequency ablation Microwave ablation High frequency focused ultrasound Cryoablation Irreversible electroporation Review 


Conflict of interest

The Authors declare no conflict of interest.


  1. 1.
    Rossi M, Orgera G, Hatzidakis A, Krokidis M (2014) Minimally invasive ablation treatment for locally advanced pancreatic adenocarcinoma. Cardiovasc Intervent Radiol 37(3):586–591PubMedCrossRefGoogle Scholar
  2. 2.
    Spiliotis J (2010) Commentary on pancreatic carcinoma: the role of radiofrequency ablation in advanced disease. Cancers 2:2055–2057PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Carrafiello G, Laganà D, Recaldini C et al (2008) Radiofrequency ablation of a pancreatic metastasis from renal cell carcinoma: case report. Surg Laparosc Endosc Percutan Tech 18(1):64–66PubMedCrossRefGoogle Scholar
  4. 4.
    Wu PH, Pan CC, Huang ZL et al (2010) Percutaneous radiofrequency ablation approach through the spleen: initial case report for pancreatic tail gastrinoma. Chin J Cancer 29(9):836–841PubMedCrossRefGoogle Scholar
  5. 5.
    Limmer S, Huppert PE, Juette V et al (2009) Radiofrequency ablation of solitary pancreatic insulinoma in a patient with episodes of severe hypoglycemia. Eur J Gastroenterol Hepatol 21(9):1097–1101PubMedCrossRefGoogle Scholar
  6. 6.
    Callery MP, Chang KJ, Fishman EK et al (2009) Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol 16:1727–1733PubMedCrossRefGoogle Scholar
  7. 7.
    Varadhachary GR, Tamm EP, Abbruzzese JL et al (2006) Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 13:1035–1046PubMedCrossRefGoogle Scholar
  8. 8.
    Matsui Y, Nakagawa A, Kamiyama Y et al (2000) Selective thermocoagulation of unresectable pancreatic cancers by using radiofrequency capacitive heating. Pancreas 20:14–20PubMedCrossRefGoogle Scholar
  9. 9.
    Elias D, Baton O, Sideris L et al (2004) Necrotizing pancreatitis after radiofrequency destruction of pancreatic tumours. Eur J Surg Oncol 30:85–87PubMedCrossRefGoogle Scholar
  10. 10.
    Date RS, Siriwardena AK (2005) Radiofrequency ablation of the pancreas. II: intra-operative ablation of non-resectable pancreatic cancer. A description of technique and initial outcome. JOP 6(6):588–592PubMedGoogle Scholar
  11. 11.
    Wu Y, Tang Z, Fang H et al (2006) High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer. J Surg Oncol 94:392–395PubMedCrossRefGoogle Scholar
  12. 12.
    Hadjicostas P, Malakounides N, Varianos C et al (2006) Radiofrequency ablation in pancreatic cancer. HPB 8:61–64PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Spiliotis JD, Datsis AC, Michalopoulos NV 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
  14. 14.
    Casadei R, Ricci C, Pezzilli R et al (2010) A prospective study on radiofrequency ablation locally advanced pancreatic cancer. Hepatobiliary Pancreat Dis Int 9(3):306–311PubMedGoogle Scholar
  15. 15.
    Cavallini M, La Torre M, Citone M 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):108–109Google Scholar
  16. 16.
    Singh V, Varshney S, Sewkani A et al (2011) Radiofrequency ablation of unresectable pancreatic carcinoma: 10-year experience from single centre. Pancreatology 11(Suppl 1):1–80Google Scholar
  17. 17.
    Cantore M, Girelli R, Mambrini A et al (2012) Combined modality treatment for patients with locally advanced pancreatic adenocarcinoma. Br J Surg 99(8):1083–1088PubMedCrossRefGoogle Scholar
  18. 18.
    Goldberg SN, Mallery S, Gazelle GS, Brugge WR (1999) EUS-guided radiofrequency ablation in the pancreas: results in a porcine model. Gastrointest Endosc 50(3):392–401PubMedCrossRefGoogle Scholar
  19. 19.
    Date RS, McMahon RF, Siriwardena AK (2005) Radiofrequency ablation of the pancreas. I: definition of optimal thermal kinetic parameters and the effect of simulated portal venous circulation in an ex vivo porcine model. JOP 6(6):581–587PubMedGoogle Scholar
  20. 20.
    Girelli R, Frigerio I, Salvia R et al (2010) Feasibility and safety of radiofrequency ablation for locally advanced pancreatic cancer. Br J Surg 97(2):220–225PubMedCrossRefGoogle Scholar
  21. 21.
    Teng LS, Jin KT, Han N, Cao J (2010) Radiofrequency ablation, heat shock protein 70 and potential antitumor immunity in hepatic and pancreatic cancers: a minireview. Hepatobiliary Pancreat Dis Int 9(4):361–365PubMedGoogle Scholar
  22. 22.
    Giardino A, Girelli R, Frigerio I et al (2013) Triple approach strategy for patients with locally advanced pancreatic carcinoma. HPB 15:623–627PubMedCrossRefGoogle Scholar
  23. 23.
    Lygidakis NJ, Sharma SK, Papastratis P et al (2007) Microwave ablation in locally advanced pancreatic carcinoma—a new look. Hepatogastroenterology 54(77):1305–1310PubMedGoogle Scholar
  24. 24.
    Carrafiello G, Ierardi AM, Fontana F et al (2013) Microwave ablation of pancreatic head cancer: safety and efficacy. J Vasc Interv Radiol 24:1513–1520PubMedCrossRefGoogle Scholar
  25. 25.
    Carrafiello G, Ierardi AM, Piacentino F et al (2012) Microwave ablation with percutaneous approach for the treatment of pancreatic adenocarcinoma. Cardiovasc Intervent Radiol 35(2):439–442PubMedCrossRefGoogle Scholar
  26. 26.
    van der Veldt AA, Meijerink MR, van den Eertwegh AJ et al (2010) Choi response criteria for early prediction of clinical outcome in patients with metastatic renal cell cancer treated with sunitinib. Br J Cancer 102(5):803–809PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45(2):228–247PubMedCrossRefGoogle Scholar
  28. 28.
    Carrafiello G, Lagana D, Mangini M et al (2008) Microwave tumors ablation: principles, clinical applications and review of preliminary experiences. Int J Surg 6(Suppl 1):S65–S69PubMedCrossRefGoogle Scholar
  29. 29.
    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):192–203CrossRefGoogle Scholar
  30. 30.
    Simon CJ, Dupuy DE, Mayo-Smith WW (2005) Microwave ablation: principles and applications. Radiographics 25:S69–S83PubMedCrossRefGoogle Scholar
  31. 31.
    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(3):275–283PubMedCrossRefGoogle Scholar
  32. 32.
    Wang X, Sun J (2002) High-intensity focused ultrasound in patients with late-stage pancreatic carcinoma. Chin Med J 115:1332–1335PubMedGoogle Scholar
  33. 33.
    Xie DR, Chen D, Teng H (2003) A multicenter non-randomized clinical study of high intensity focused ultrasound in treating patients with local advanced pancreatic carcinoma. Zhongguo Zhongliu Linchuang 30:630–634Google Scholar
  34. 34.
    Xu YQ, Wang GM, Gu YZ, Zhang HF (2003) The acesodyne effect of high intensity focused ultrasound on the treatment of advanced pancreatic carcinoma. Zhongguo Linchuang Yixue 10:322–323Google Scholar
  35. 35.
    Yuan C, Yang L, Yao C (2003) Observation of high intensity focused ultrasound treating 40 cases of pancreatic cancer. Linchuang Gandanbing Zazhi 19:145–146Google Scholar
  36. 36.
    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
  37. 37.
    Wu F, Wang ZB, Zhu H et al (2005) Feasibility of US-guided high-intensity focused ultrasound treatment in patients with advanced pancreatic cancer: initial experience. Radiology 236:1034–1040PubMedCrossRefGoogle Scholar
  38. 38.
    Xiong LL, Hwang JH, Huang XB et al (2009) Early clinical experience using high intensity focused ultrasound for palliation of inoperable pancreatic cancer. JOP 10:123–129PubMedGoogle Scholar
  39. 39.
    Zhao H, Yang G, Wang D et al (2010) Concurrent gemcitabine and high-intensity focused ultrasound therapy in patients with locally advanced pancreatic cancer. Anticancer Drugs 21:447–452PubMedCrossRefGoogle Scholar
  40. 40.
    Orgera G, Krokidis M, Monfardini L et al (2011) High intensity focused ultrasound ablation of pancreatic neuroendocrine tumours: report of two cases. Cardiovasc Intervent Radiol 34(2):419–423PubMedCrossRefGoogle Scholar
  41. 41.
    Orgera G, Krokidis M, Monfardini L 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
  42. 42.
    Sung HY, Jung SE, Cho SH et al (2011) Long-term outcome of high-intensity focused ultrasound in advanced pancreatic cancer. Pancreas 40:1080–1108PubMedCrossRefGoogle Scholar
  43. 43.
    Li PZ, Zhu SH, He W et al (2012) High-intensity focused ultrasound treatment for patients with unresectable pancreatic cancer. Hepatobiliary Pancreat Dis Int 11:655–660PubMedCrossRefGoogle Scholar
  44. 44.
    Hwang JH, Wang YN, Warren C et al (2009) Preclinical in vivo evaluation of an extracorporeal HIFU device for ablation of pancreatic tumors. Ultrasound Med Biol 35(6):967–975PubMedCrossRefGoogle Scholar
  45. 45.
    Jang HJ, Lee JY, Lee DH et al (2010) Current and future clinical applications of high intensity focused ultrasound (HIFU) for pancreatic cancer. Gut Liver 4(Suppl 1):57–61CrossRefGoogle Scholar
  46. 46.
    Wang K, Chen Z, Meng Z et al (2011) Analgesic effect of high intensity focused ultrasound therapy for unresectable pancreatic cancer. Int J Hyperthermia 27:101–107PubMedCrossRefGoogle Scholar
  47. 47.
    Lee JY, Choi BI, Ryu JK et al (2011) Concurrent chemotherapy and pulsed high-intensity focused ultrasound therapy for the treatment of unresectable pancreatic cancer: initial experiences. Korean J Radiol 12:176–186PubMedCentralPubMedCrossRefGoogle Scholar
  48. 48.
    Kovach SJ, Hendrickson RJ, Cappadona CR et al (2002) Cryoablation of unresectable pancreatic cancer. Surgery 131(4):463Y464CrossRefGoogle Scholar
  49. 49.
    Xu KC, Niu LZ, Hu YZ et al (2008) A pilot study on combination of cryosurgery and (125)iodine seed implantation for treatment of locally advanced pancreatic cancer. World J Gastroenterol 14(10):1603Y1611CrossRefGoogle Scholar
  50. 50.
    Li J, Chen X, Yang H et al (2011) Tumour cryoablation combined with palliative bypass surgery in the treatment of unresectable pancreatic cancer: a retrospective study of 142 patients. Postgrad Med J 87(1024):89–95PubMedCrossRefGoogle Scholar
  51. 51.
    Niu L, Chen J, He L et al (2013) Combination treatment with comprehensive cryoablation and immunotherapy in metastatic pancreatic cancer. Pancreas 42:1143–1149PubMedCrossRefGoogle Scholar
  52. 52.
    Li J, Zhang C, Chen J et al (2013) Two case reports of pilot percutaneous cryosurgery in familial multiple endocrine neoplasia type 1. Pancreas 42(2):353–357PubMedCrossRefGoogle Scholar
  53. 53.
    Zhou XD (1992) Cryosurgery for primary hepatic cancer of 87 patients. Zhonghua Wai Ke Za Zhi 30(6):334–336, 381PubMedGoogle Scholar
  54. 54.
    Patiutko IuI, Barkanov AI, Kholikov TK et al (1991) The combined treatment of locally disseminated pancreatic cancer using cryosurgery. Vopr Onkol 37:695–700PubMedGoogle Scholar
  55. 55.
    Li B, Li JD, Chen XL et al (2004) Cryosurgery for unresectable pancreatic carcinoma: a report of 44 cases. Zhonghua Gandan Waike Zazhi 10:523–525Google Scholar
  56. 56.
    Wu Q, Zhang JX, Qian JX et al (2005) The application of surgical treatment in combination with targeted cryoablation on advanced carcinoma of head of pancreas: a report of 15 cases. Zhongguo Zhongliu Linchuang 32:1403–1405Google Scholar
  57. 57.
    Korpan NN (2007) Cryosurgery: ultrastructural changes in pancreas tissue after low temperature exposure. Technol Cancer Res Treat 6:59–67PubMedGoogle Scholar
  58. 58.
    Niu L, He L, Zhou L et al (2012) Percutaneous ultrasonography and computed tomography guided pancreatic cryoablation: feasibility and safety assessment. Cryobiology 65:301–307PubMedCrossRefGoogle Scholar
  59. 59.
    Bagla S, Papadouris D (2012) Percutaneous irreversible electroporation of surgically unresectable pancreatic cancer: a case report. J Vasc Interv Radiol 23(1):142–145PubMedCrossRefGoogle Scholar
  60. 60.
    Martin RC 2nd, McFarland K, Ellis S, Velanovich V (2012) Irreversible electroporation therapy in the management of locally advanced pancreatic adenocarcinoma. J Am Coll Surg 215(3):361–369PubMedCrossRefGoogle Scholar
  61. 61.
    Narayanan G, Hosein PJ, Arora G et al (2012) Percutaneous irreversible electroporation for downstaging and control of unresectable pancreatic adenocarcinoma. Vasc Interv Radiol 23(12):1613–1621CrossRefGoogle Scholar
  62. 62.
    Martin RC 2nd, McFarland K, Ellis S, Velanovich V (2013) Irreversible electroporation in locally advanced pancreatic cancer: potential improved overall survival. Ann Surg Oncol 20 Suppl 3:443–449CrossRefGoogle Scholar
  63. 63.
    Månsson C, Bergenfeldt M, Brahmstaedt R et al (2014) Safety and preliminary efficacy of ultrasound-guided percutaneous irreversible electroporation for treatment of localized pancreatic cancer. Anticancer Res 34(1):289–293PubMedGoogle Scholar
  64. 64.
    Lee EW, Loh CT, Kee ST (2007) Imaging guided percutaneous irreversible electroporation: ultrasound and immunohistological correlation. Technol Cancer Res Treat 6:287–293PubMedGoogle Scholar
  65. 65.
    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
  66. 66.
    Thomson KR, Cheung W, Ellis SJ et al (2011) Investigation of the safety of irreversible electroporation in humans. J Vasc Interv Radiol 22:611–621PubMedCrossRefGoogle Scholar
  67. 67.
    Edd JF, Horowitz L, Davalos RV et al (2006) In vivo results of a new focal tissue ablation technique: irreversible electroporation. IEEE Trans Bio-med Eng 53:1409–1415CrossRefGoogle Scholar
  68. 68.
    Ierardi AM, Floridi C, Fontana F et al (2013) Microwave ablation of liver metastases to overcome the limitations of radiofrequency ablation. Radiol Med 118(6):949–961PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Medical Radiology 2014

Authors and Affiliations

  • Anna Maria Ierardi
    • 1
  • Natalie Lucchina
    • 1
  • Mario Petrillo
    • 2
  • Chiara Floridi
    • 1
  • Filippo Piacentino
    • 1
  • Alessandro Bacuzzi
    • 3
  • Paolo Fonio
    • 4
  • Federico Fontana
    • 1
  • Carlo Fugazzola
    • 1
  • Luca Brunese
    • 5
  • Gianpaolo Carrafiello
    • 1
  1. 1.Department of Radiology, Interventional RadiologyInsubria UniversityVareseItaly
  2. 2.Department of RadiologySecond University of NaplesNaplesItaly
  3. 3.Anaesthesia and Palliative CareUniversity of Insubria, Ospedale di Circolo e Fondazione MacchiVareseItaly
  4. 4.Institute of RadiologyUniversity of TurinTurinItaly
  5. 5.Department of RadiologyUniversità degli Studi del MoliseCampobassoItaly

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