Dedication
Diese Übersichtsarbeit widmen wir Herrn Univ.-Prof. Dr. med. Hans H. Schild, bei dem
wir uns ganz herzlich für die langjährige und stete Unterstützung in allen klinischen
und wissenschaftlichen Belangen bedanken möchten.
Abstract
Background Locally advanced pancreatic cancer is a life-limiting tumor with a wide range of
incapacitating symptoms such as cancer-associated pain. Several local ablative therapies
with both thermal and non-thermal sources have recently received significant attention
as modern treatment options for local tumor control and symptomatic improvement. The
following review article provides an overview of currently available techniques and
their outcomes including our own experience with high-intensity focused ultrasound
(HIFU) being one of the most exciting and innovative modalities.
Method Our experiences with HIFU treatment are based on 89 pancreatic cancer patients (UICC
III-IV). Outcomes such as treatment-related changes in symptoms particularly in cancer
pain and quality of life as well as local tumor response, safety and survival were
compared to reported studies concerning HIFU, radiofrequency and microwave ablation,
cryoablation, irreversible electroporation and stereotactic body radiation therapy.
Results Even though all strategies appeared to be feasible, the unique feature of noninvasiveness
represents a substantial advantage of the HIFU procedure. In 85 % of HIFU-treated
patients, long-lasting pain relief was achieved. 50 % of patients did not require
any analgesic treatment 6 weeks post-ablation. Unfortunately, pain palliation and
quality-of-life outcomes are only rarely reported for other local treatment modalities.
Tumor mass reduction could be achieved with all ablative therapies, with a mean tumor
volume reduction of 60 % after 6 months in HIFU-treated pancreatic tumors. Differences
in treatment-associated morbidity were reported. However, they are only partially
comparable due to unbalanced study populations.
Conclusion Various local ablative treatment modalities are available and feasible for tumor
mass reduction of advanced pancreatic cancer but with different symptomatic benefit
for patients. An effective and long-lasting reduction of cancer-related pain was observed
following HIFU without insertion of needles or electrodes. Randomized controlled studies
for head-to-head comparison of these modalities are warranted in the near future.
Key points:
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Several ablative therapies are available for the local treatment of inoperable pancreatic
cancer.
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Tumor mass and symptom reduction are main goals of local therapies.
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HIFU differs based on its noninvasive approach and low complication rate.
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HIFU enables effective long-lasting pain relief in > 80 % of patients.
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HIFU-associated pain relief is independent of tumor stage and metastatic status.
Citation Format
Key words
abdomen - pancreas - ablation procedures - interventional procedures - ultrasound
- adenocarcinoma
