Crinò Stefano Francesco, Conti Bellocchi Maria Cristina, Paiella Salvatore, Gabbrielli Armando
Recenti Prog Med. 2021 Jan;112(1):75-80. doi: 10.1701/3525.35127.
The interest for pancreatic neoplasm ablation under endoscopic ultrasound (EUS) guidance has increased during the last decade because of technology advancement and availability of dedicated devices for thermal ablation. The most commonly used technique is radiofrequency ablation (RFA). Currently, three needle-electrodes and one "through-the-needle" probe are available. Published studies mainly demonstrated the feasibility and safety of the procedure. However, the role of EUS-RFA for the treatment of pancreatic ductal adenocarcinoma is not yet well defined. Randomized studies are needed to assess any advantage in terms of survival and quality of life when RFA is included in a multimodal treatment strategy compared with chemo(radio)therapy alone. In the setting of pancreatic neuroendocrine tumors (pNETs), published studies are consistent in demonstrating the efficacy of EUS-RFA in relieving symptoms related to hormone secretion by functioning pNETs. Moreover, EUS-RFA could find a role even in selected patients with small non-functioning pNETs when treatment is indicated but surgical resection would like to be avoided. Finally, EUS-RFA can be applied also for the treatment of pancreatic cystic neoplasm. However, patients should be carefully selected taking into account the low incidence of progression of cystic neoplasms towards malignancy and factors related to the patient, such as age, symptoms, comorbidity, and life expectancy.
在过去十年中，由于技术进步以及热消融专用设备的出现，内镜超声（EUS）引导下胰腺肿瘤消融的关注度有所增加。最常用的技术是射频消融（RFA）。目前，有三种针状电极和一种“经针”探头可供使用。已发表的研究主要证明了该手术的可行性和安全性。然而，EUS-RFA在治疗胰腺导管腺癌中的作用尚未明确界定。需要进行随机研究，以评估与单纯化疗（放疗）相比，当RFA纳入多模式治疗策略时，在生存和生活质量方面是否有任何优势。在胰腺神经内分泌肿瘤（pNETs）方面，已发表的研究一致表明EUS-RFA在缓解功能性pNETs激素分泌相关症状方面的疗效。此外，当有治疗指征但希望避免手术切除时，EUS-RFA在某些小的无功能性pNETs患者中也可能发挥作用。最后，EUS-RFA也可用于治疗胰腺囊性肿瘤。然而，考虑到囊性肿瘤向恶性进展的发生率较低以及与患者相关的因素，如年龄、症状、合并症和预期寿命，应仔细选择患者。
