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Minimally Invasive Ablation Treatment for Locally Advanced Pancreatic Adenocarcinoma

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Abstract

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.

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References

  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 7:486–491

    PubMed  Google Scholar 

  2. Jemal A, Thomas A, Murray T, Thun M (2002) Cancer statistics, 2002. CA Cancer J Clin 52:23–47

    Article  PubMed  Google Scholar 

  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 16:1727–1733

    Article  PubMed  Google Scholar 

  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 13:1035–1046

    Article  PubMed  Google Scholar 

  5. Ghaneh P, Kawesha A, Howes N, Jones L, Neoptolemos JP (1999) Adjuvant therapy for pancreatic cancer. World J Surg 23:937–945

    Article  CAS  PubMed  Google Scholar 

  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 4:1–15

    Article  CAS  Google Scholar 

  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 29:4105–4112

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  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 364:1817–1825

    Google Scholar 

  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 29:4105–4112

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  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 25:326–331

    Article  CAS  PubMed  Google Scholar 

  11. Jurgensen C, Schuppan D, Neser F, Ernstberger J, Junghans U, Stolzel U (2006) EUS-guided alcohol ablation of an insulinoma. Gastrointest Endosc 63:1059–1062

    Article  PubMed  Google Scholar 

  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):074003

    Article  PubMed  Google Scholar 

  13. Robinson D, Halperin N, Nevo Z (2001) Two freezing cycles ensure interface sterilization by cryosurgery during bone tumor resection. Cryobiology 43:4–10

    Article  CAS  PubMed  Google Scholar 

  14. Habash RW, Bansal R, Krewski D, Alhafid HT (2007) Thermal therapy, part III: ablation techniques. Crit Rev Biomed Eng 35(1–2):37–121

    Article  PubMed  Google Scholar 

  15. Goldberg SN, Mallery S, Gazelle GS, Brugge WR (1999) EUS-guided radiofrequency ablation in the pancreas: results in a porcine model. Gastrointest Endosc 50:392–401

    Article  CAS  PubMed  Google Scholar 

  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 30:266–271

    Article  PubMed  Google Scholar 

  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 20:14–20

    Article  CAS  PubMed  Google Scholar 

  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. 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 97:220–225

    Article  CAS  PubMed  Google Scholar 

  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 392:55–60

    Article  PubMed  Google Scholar 

  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):52

    Google Scholar 

  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 94:392–395

    Article  PubMed  Google Scholar 

  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

    PubMed  Google Scholar 

  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–E109

    PubMed  Google Scholar 

  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–S203

    Article  PubMed Central  PubMed  Google Scholar 

  26. Simon CJ, Dupuy DE, Mayo-Smith WW (2005) Microwave ablation: principles and applications. Radiographics 25:S69–S83

    Article  PubMed  Google Scholar 

  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 10:275–283

    Article  PubMed  Google Scholar 

  28. Shock SA, Meredith K, Warner TF (2004) Microwave ablation with loop antenna: in vivo porcine liver model. Radiology 231:143–149

    Article  PubMed  Google Scholar 

  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):1305–1310

    CAS  PubMed  Google Scholar 

  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 35:439–442

    Article  Google Scholar 

  31. Dubinsky TJ, Cuevas C, Dighe MK (2008) High-intensity focused ultrasound: current potential and oncologic applications. AJR Am J Roentgenol 190:191–199

    Article  PubMed  Google Scholar 

  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 51–56

    Google Scholar 

  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 27:1099–1106

    Article  CAS  PubMed  Google Scholar 

  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 19:145–146

    Google Scholar 

  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):1258–1261

    Article  PubMed  Google Scholar 

  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):734–748

    Article  CAS  PubMed  Google Scholar 

  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):419–423

    Article  PubMed  Google Scholar 

  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, USA

  39. Granot Y, Rubinsky B (2008) Mass transfer model for drug delivery in tissue cells with reversible electroporation. Int J Heat Mass Transf 51:5610–5616

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  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 49:1262–1283

    Article  CAS  PubMed  Google Scholar 

  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 6:243–273

    Article  PubMed  Google Scholar 

  42. Lee RC (2005) Cell injury by electric forces. Ann N Y Acad Sci 1066:85–91

    Article  CAS  PubMed  Google Scholar 

  43. Davalos RV, Mir IL, Rubinsky B (2005) Tissue ablation with irreversible electroporation. Ann Biomed Eng 33:223–231

    Article  CAS  PubMed  Google Scholar 

  44. Rubinsky B, Onik G, Mikus P (2007) Irreversible electroporation: a new ablation modality—clinical implications. Technol Cancer Res Treat 6:37–48

    PubMed  Google Scholar 

  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 53:1409–1415

    Article  PubMed  Google Scholar 

  46. Maor E, Ivorra A, Leor J, Rubinsky B (2007) The effect of irreversible electroporation on blood vessels. Technol Cancer Res Treat 6:307–312

    PubMed  Google Scholar 

  47. Bower M, Sherwood L, Li Y, Martin R (2011) Irreversible electroporation of the pancreas: definitive local therapy without systemic effects. J Surg Oncol 104:22–28

    Article  PubMed  Google Scholar 

  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. 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 23:1613–1621

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Unit of Interventional Radiology, S. Andrea University Hospital “Sapienza”, Rome, Italy

    Michele Rossi & Gianluigi Orgera

  2. Department of Radiology, Medical School of Crete, University Hospital of Heraklion, Heraklion, Greece

    Adam Hatzidakis

  3. Department of Radiology, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK

    Miltiadis Krokidis

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  1. Michele Rossi
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  2. Gianluigi Orgera
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  3. Adam Hatzidakis
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  4. Miltiadis Krokidis
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Correspondence to Miltiadis Krokidis.

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Rossi, M., Orgera, G., Hatzidakis, A. et al. Minimally Invasive Ablation Treatment for Locally Advanced Pancreatic Adenocarcinoma. Cardiovasc Intervent Radiol 37, 586–591 (2014). https://doi.org/10.1007/s00270-013-0724-x

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  • DOI: https://doi.org/10.1007/s00270-013-0724-x

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