Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2021; 27(27): 4322-4341
Published online Jul 21, 2021. doi: 10.3748/wjg.v27.i27.4322
Minimally invasive image-guided therapy of primary and metastatic pancreatic cancer
Andras Bibok, Dae Won Kim, Mokenge Malafa, Bela Kis
Andras Bibok, Bela Kis, Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, United States
Andras Bibok, Department of Transplantation & Surgery, Radiology Unit, Semmelweis University, Budapest 1085, Hungary
Dae Won Kim, Mokenge Malafa, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, United States
Author contributions: Bibok A did literature review, wrote the first draft, edited final version; Kis B created the structure of the manuscript, wrote part of the manuscript and provided critical review and edited the manuscript; Kim DW and Malafa M provided critical review and edited the manuscript; all authors have read and approved the final manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bela Kis, MD, PhD, Associate Professor, Doctor, Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, United States. bela.kis@moffitt.org
Received: February 9, 2021
Peer-review started: February 9, 2021
First decision: May 13, 2021
Revised: May 21, 2021
Accepted: June 23, 2021
Article in press: June 23, 2021
Published online: July 21, 2021
Abstract

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.

Keywords: Pancreatic neoplasms, Interventional radiology, Ablation techniques, Electroporation, Radiofrequency ablation, Therapeutic embolization

Core Tip: 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 pancreatic cancer and the low comorbid risk of these procedures. This review summarizes new ablative options for patients with locally advanced pancreatic cancer and percutaneous liver-directed therapies for patients with liver-dominant metastatic disease.