Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.
Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.
Eur J Surg Oncol. 2018 Oct;44(10):1486-1493. doi: 10.1016/j.ejso.2018.07.047. Epub 2018 Aug 2.
The incidence of pancreatic ductal adenocarcinoma (PDAC) is rapidly increasing. Up to 30% of patients present with locally advanced disease and therefore are not candidates for surgery. Locally advanced pancreatic cancer (LAPC) is an emerging entity lacking in level III evidence-based recommendations for its treatment. Currently, systemic chemotherapy is the main treatment for LAPC. However, due to lack of response or disease progression, downsizing of the tumour, making it resectable is successful in only a small proportion of patients. Radiotherapy is often advocated to improve local disease control if there is stability following chemotherapy. Recently, Irreversible Electroporation (IRE), a novel non-thermal ablation technique, has been proposed for the treatment of LAPC.
This narrative review aims to explore the potential role and timing for the use of IRE in patients with LAPC.
To date, there is limited and inconsistent level I and II evidence available in the literature regarding the use of IRE for the treatment of PDAC.
Although some of the preliminary experience of the use of IRE in patients with LAPC is encouraging, it should only be used after conventional evidence-based treatments and/or within the research context.
胰腺导管腺癌 (PDAC) 的发病率正在迅速上升。多达 30%的患者表现为局部晚期疾病，因此不适合手术。局部晚期胰腺癌 (LAPC) 是一种新兴实体，缺乏针对其治疗的 III 级循证推荐。目前，全身化疗是 LAPC 的主要治疗方法。然而，由于缺乏反应或疾病进展，肿瘤缩小，使其可切除的成功比例仅为一小部分患者。如果化疗后病情稳定，放射治疗通常被提倡用于改善局部疾病控制。最近，不可逆电穿孔 (IRE) 作为一种新型非热消融技术，已被提议用于治疗 LAPC。
本综述旨在探讨 IRE 在 LAPC 患者中的潜在作用和应用时机。
迄今为止，关于 IRE 治疗 PDAC 的应用，文献中仅有有限的、不一致的 I 级和 II 级证据。
尽管在 LAPC 患者中使用 IRE 的一些初步经验令人鼓舞，但它应该仅在常规循证治疗之后使用和/或在研究背景下使用。
