Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, United States.
Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, United States.
World J Gastroenterol. 2021 Jul 21;27(27):4322-4341. doi: 10.3748/wjg.v27.i27.4322.
Pancreatic cancer is a challenging malignancy with limited treatment options and poor life expectancy. The only curative option is surgical resection, but only 15%-20% of patients are resectable at presentation because more than 50% of patients has distant metastasis at diagnosis and the rest of them has locally advanced pancreatic cancer (LAPC). The standard of care first line treatment for LAPC patients is chemotherapy with or without radiation therapy. Recent developments in minimally invasive ablative techniques may add to the treatment armamentarium of LAPC. There are increasing number of studies evaluating these novel ablative techniques, including radiofrequency ablation, microwave ablation, cryoablation and irreversible electroporation. Most studies which included pancreatic tumor ablation, demonstrated improved overall survival in LAPC patients. However, the exact protocols are yet to set up to which stage of the treatment algorithm ablative techniques can be added and in what kind of treatment combinations. Patients with metastatic pancreatic cancer has dismal prognosis with 5-year survival is only 3%. The most common metastatic site is the liver as 90% of pancreatic cancer patients develop liver metastasis. Chemotherapy is the primary treatment option for patients with metastatic pancreatic cancer. However, when the tumor is not responding to chemotherapy or severe drug toxicity develops, locoregional liver-directed therapies can provide an opportunity to control intrahepatic disease progression and improve survival in selected patients. During the last decade new therapeutic options arose with the advancement of minimally invasive technologies to treat pancreatic cancer patients. These new therapies have been a topic of increasing interest due to the severe prognostic implications of locally advanced and metastatic pancreatic cancer and the low comorbid risk of these procedures. This review summarizes new ablative options for patients with LAPC and percutaneous liver-directed therapies for patients with liver-dominant metastatic disease.
胰腺癌是一种具有挑战性的恶性肿瘤，治疗选择有限，预期寿命短。唯一的治愈方法是手术切除，但只有 15%-20%的患者在就诊时可切除，因为超过 50%的患者在诊断时已经发生远处转移，其余患者则患有局部晚期胰腺癌（LAPC）。LAPC 患者的一线治疗标准是化疗联合或不联合放疗。微创消融技术的最新进展可能为 LAPC 的治疗手段增添新方法。越来越多的研究评估了这些新的消融技术，包括射频消融、微波消融、冷冻消融和不可逆电穿孔。大多数包含胰腺肿瘤消融的研究表明，LAPC 患者的总生存期得到改善。然而，确切的方案仍有待确定，消融技术可以添加到治疗算法的哪个阶段，以及哪种治疗组合中。转移性胰腺癌患者预后极差，5 年生存率仅为 3%。最常见的转移部位是肝脏，因为 90%的胰腺癌患者会发生肝转移。化疗是转移性胰腺癌患者的主要治疗选择。然而，当肿瘤对化疗无反应或出现严重的药物毒性时，局部肝脏导向治疗可以为控制肝内疾病进展和改善选定患者的生存提供机会。在过去十年中，随着微创技术的进步，出现了治疗胰腺癌患者的新治疗选择。这些新的治疗方法引起了越来越多的关注，因为局部晚期和转移性胰腺癌的预后严重，这些手术的合并症风险低。本文综述了 LAPC 患者的新消融选择以及肝优势转移性疾病患者的经皮肝脏导向治疗。
