Wray Curtis J, O'Brien Baylee, Cen Putao, Rowe Julie H, Faraoni Erika Y, Bailey Jennifer M, Rubin Erin, Tammisetti Varaha S, Thosani Nirav
Department of Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA.
Department of Anesthesiology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA.
Gastrointest Endosc. 2024 Oct;100(4):759-766. doi: 10.1016/j.gie.2024.04.2926. Epub 2024 May 8.
Emerging data suggest neoadjuvant chemotherapy (NAC) for resectable pancreatic ductal adenocarcinoma (PDAC) is associated with improved survival. However, less than 40% of patients demonstrate a meaningful radiographic response to NAC. EUS-guided radiofrequency ablation (EUS-RFA) has emerged as a new modality to treat PDAC. We hypothesize that NAC plus EUS-RFA can be used in the management of resectable PDAC.
This was a prospective review of PDAC patients meeting the criteria of resectable tumor anatomy who underwent NAC chemotherapy plus EUS-RFA followed by pancreatic resection. Radiographic imaging and perioperative and short-term outcomes were recorded. Surgical pathology specimens were analyzed for treatment response.
Three eligible patients with resectable PDAC received 4 months of NAC plus EUS-RFA. One month after completing NAC and EUS-RFA, all 3 patients underwent standard pancreaticoduodenectomy without adverse events. After a 6-week recovery, all patients completed 2 months of postoperative adjuvant chemotherapy.
In our institutional experience, this treatment protocol appears to be safe as patients tolerated the combination of chemotherapy and ablation. Patients underwent pancreatic resection with uneventful recovery. This novel neoadjuvant approach may provide a more effective alternative to chemotherapy alone.
新出现的数据表明，可切除的胰腺导管腺癌（PDAC）新辅助化疗（NAC）与生存率提高相关。然而，不到40%的患者对NAC有显著的影像学反应。超声内镜引导下射频消融术（EUS-RFA）已成为治疗PDAC的一种新方法。我们假设NAC联合EUS-RFA可用于可切除PDAC的治疗。
这是一项对符合可切除肿瘤解剖学标准的PDAC患者的前瞻性研究，这些患者接受了NAC化疗加EUS-RFA，随后进行胰腺切除术。记录影像学检查结果、围手术期和短期结局。对手术病理标本进行治疗反应分析。
3例符合条件的可切除PDAC患者接受了4个月的NAC加EUS-RFA。完成NAC和EUS-RFA 1个月后，所有3例患者均接受了标准的胰十二指肠切除术，无不良事件发生。经过6周的恢复，所有患者均完成了2个月的术后辅助化疗。
根据我们机构的经验，该治疗方案似乎是安全的，因为患者耐受化疗和消融的联合治疗。患者接受了胰腺切除术，恢复顺利。这种新的新辅助治疗方法可能为单纯化疗提供更有效的替代方案。
