Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
Br J Surg. 2015 Feb;102(3):182-93. doi: 10.1002/bjs.9716. Epub 2014 Dec 18.
Locally advanced pancreatic cancer (LAPC) is associated with a very poor prognosis. Current palliative (radio)chemotherapy provides only a marginal survival benefit of 2-3 months. Several innovative local ablative therapies have been explored as new treatment options. This systematic review aims to provide an overview of the clinical outcomes of these ablative therapies.
A systematic search in PubMed, Embase and the Cochrane Library was performed to identify clinical studies, published before 1 June 2014, involving ablative therapies in LAPC. Outcomes of interest were safety, survival, quality of life and pain.
After screening 1037 articles, 38 clinical studies involving 1164 patients with LAPC, treated with ablative therapies, were included. These studies concerned radiofrequency ablation (RFA) (7 studies), irreversible electroporation (IRE) (4), stereotactic body radiation therapy (SBRT) (16), high-intensity focused ultrasound (HIFU) (5), iodine-125 (2), iodine-125-cryosurgery (2), photodynamic therapy (1) and microwave ablation (1). All strategies appeared to be feasible and safe. Outcomes for postoperative, procedure-related morbidity and mortality were reported only for RFA (4-22 and 0-11 per cent respectively), IRE (9-15 and 0-4 per cent) and SBRT (0-25 and 0 per cent). Median survival of up to 25·6, 20·2, 24·0 and 12·6 months was reported for RFA, IRE, SBRT and HIFU respectively. Pain relief was demonstrated for RFA, IRE, SBRT and HIFU. Quality-of-life outcomes were reported only for SBRT, and showed promising results.
Ablative therapies in patients with LAPC appear to be feasible and safe.
局部晚期胰腺癌（LAPC）预后极差。目前的姑息（放）化疗仅能提供 2-3 个月的生存获益。几种创新的局部消融治疗方法已被探索作为新的治疗选择。本系统评价旨在提供这些消融治疗的临床疗效概述。
在 PubMed、Embase 和 Cochrane 图书馆进行系统检索，以确定截至 2014 年 6 月 1 日之前发表的涉及 LAPC 消融治疗的临床研究。感兴趣的结局包括安全性、生存、生活质量和疼痛。
经过筛选 1037 篇文章，纳入了 38 项涉及 1164 例 LAPC 患者接受消融治疗的临床研究。这些研究涉及射频消融（RFA）（7 项）、不可逆电穿孔（IRE）（4 项）、立体定向体部放射治疗（SBRT）（16 项）、高强度聚焦超声（HIFU）（5 项）、碘 125（2 项）、碘 125 冷冻手术（2 项）、光动力疗法（1 项）和微波消融（1 项）。所有策略似乎都是可行且安全的。仅报道了 RFA（分别为 4-22%和 0-11%）、IRE（9-15%和 0-4%）和 SBRT（0-25%和 0%）术后、与手术相关的发病率和死亡率。RFA、IRE、SBRT 和 HIFU 的中位生存时间分别为 25.6、20.2、24.0 和 12.6 个月。RFA、IRE、SBRT 和 HIFU 均能缓解疼痛。仅报道了 SBRT 的生活质量结果，结果令人鼓舞。
LAPC 患者的消融治疗似乎是可行且安全的。
