LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon 69003, France.
Department of Gastroenterology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon 69008, France.
World J Gastroenterol. 2022 Apr 7;28(13):1288-1303. doi: 10.3748/wjg.v28.i13.1288.
Pancreatic ductal adenocarcinoma (PDAC) is expected to become the second leading cause of death from cancer by 2030. Despite intensive research in the field of therapeutics, the 5-year overall survival is approximately 8%, with only 20% of patients eligible for surgery at the time of diagnosis. The tumoral microenvironment (TME) of the PDAC is one of the main causes for resistance to antitumoral treatments due to the presence of tumor vasculature, stroma, and a modified immune response. The TME of PDAC is characterized by high stiffness due to fibrosis, with hypo microvascular perfusion, along with an immunosuppressive environment that constitutes a barrier to effective antitumoral treatment. While systemic therapies often produce severe side effects that can alter patients' quality of life, locoregional therapies have gained attention since their action is localized to the pancreas and can thus alleviate some of the barriers to effective antitumoral treatment due to their physical effects. Local hyperthermia using radiofrequency ablation and radiation therapy - most commonly using a local high single dose - are the two main modalities holding promise for clinical efficacy. Recently, irreversible electroporation and focused ultrasound-derived cavitation have gained increasing attention. To date, most of the data are limited to preclinical studies, but ongoing clinical trials may help better define the role of these locoregional therapies in the management of PDAC patients.
胰腺导管腺癌（PDAC）预计将成为 2030 年癌症死亡的第二大主要原因。尽管在治疗领域进行了深入研究，但 5 年总生存率约为 8%，只有 20%的患者在诊断时适合手术。由于肿瘤血管、基质和免疫反应的改变，胰腺导管腺癌的肿瘤微环境（TME）是导致抗肿瘤治疗耐药的主要原因之一。由于纤维化导致的高硬度、低微血管灌注以及免疫抑制环境，构成了有效抗肿瘤治疗的障碍。虽然全身治疗通常会产生严重的副作用，从而改变患者的生活质量，但由于局部区域治疗的作用局限于胰腺，因此可以减轻一些由于物理效应而导致的有效抗肿瘤治疗的障碍，因此引起了关注。局部射频消融和放射治疗（最常使用局部高单次剂量）的局部高热是两种具有临床疗效潜力的主要方式。最近，不可逆电穿孔和聚焦超声衍生的空化也引起了越来越多的关注。迄今为止，大多数数据仅限于临床前研究，但正在进行的临床试验可能有助于更好地确定这些局部区域治疗在 PDAC 患者管理中的作用。
