Vemulapalli Varun, Natha Cristina, Thosani Nirav
Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
Department of Surgery and Interventional Gastroenterology, The University of Texas Health Science Center and McGovern School of Medicine, Houston, TX 77030, USA.
Cancers (Basel). 2025 Jun 23;17(13):2091. doi: 10.3390/cancers17132091.
Pancreatic ductal adenocarcinoma (PDAC) remains one of the most challenging malignancies to treat, largely due to late diagnosis, limited surgical options, and profound resistance to systemic therapies, all of which contribute to a five-year survival rate of approximately 9%. The dense, hypoxic, and immunosuppressive tumor microenvironment (TME) of PDAC plays a critical role in immune evasion and therapeutic failure. As conventional immunotherapies have shown limited efficacy in PDAC, attention has shifted toward local interventions capable of remodeling the TME to enhance immune responsiveness. Endoscopic ultrasound (EUS)-guided ablative therapies have emerged as promising strategies to overcome these barriers. A range of modalities-including irreversible electroporation, microwave ablation, photodynamic therapy, and cryoablation-are under investigation. Among these, radiofrequency ablation (RFA) stands out as the most promising therapy as it not only induces direct tumor cytoreduction but also promotes antigen release, triggers immunogenic cell death, and may work synergistically with systemic therapies such as immune checkpoint inhibitors and adenosine pathway blockade. This review aims to explore the evolving role of endoscopic ablative therapies with a focus on RFA as a potential platform for immune activation in pancreatic cancer.
胰腺导管腺癌（PDAC）仍然是最难治疗的恶性肿瘤之一，这主要是由于诊断较晚、手术选择有限以及对全身治疗具有高度抗性，所有这些因素导致其五年生存率约为9%。PDAC致密、缺氧且具有免疫抑制性的肿瘤微环境（TME）在免疫逃逸和治疗失败中起着关键作用。由于传统免疫疗法在PDAC中疗效有限，人们的注意力已转向能够重塑TME以增强免疫反应性的局部干预措施。内镜超声（EUS）引导下的消融治疗已成为克服这些障碍的有前景的策略。一系列治疗方式——包括不可逆电穿孔、微波消融、光动力疗法和冷冻消融——正在研究中。其中，射频消融（RFA）最为突出，是最有前景的治疗方法，因为它不仅能直接诱导肿瘤细胞减少，还能促进抗原释放，引发免疫原性细胞死亡，并且可能与免疫检查点抑制剂和腺苷通路阻断等全身治疗协同作用。本综述旨在探讨内镜消融治疗不断演变的作用，重点关注RFA作为胰腺癌免疫激活潜在平台的作用。
