Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000068.xml
Semin intervent Radiol 2019; 36(03): 203-212
DOI: 10.1055/s-0039-1693118
DOI: 10.1055/s-0039-1693118
Review Article
Ablative, Endovascular, and Biliary Interventions for Patients with Pancreatic Cancer
Further Information
Publication History
Publication Date:
19 August 2019 (online)
![](https://www.thieme-connect.de/media/sir/201903/lookinside/thumbnails/10-1055-s-0039-1693118_001149-1.jpg)
Abstract
Interventional radiologists have multiple points of involvement in the treatment and management of patients with pancreatic adenocarcinoma. There is increasing interest in cytoreductive treatment of the primary tumor as well as metastatic disease via arterial and ablative techniques. The focus of this article is on the current evidence for pancreatic irreversible electroporation. For patients undergoing curative surgery or terminal palliation, interventional radiology can manage complications and symptoms. In this article, therapeutic and palliative options in this group of patients including postoperative embolization, biliary drainage, and stent placement are reviewed.
-
References
- 1 Cancer Facts & Figures 2018 | American Cancer Society. Available at: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2018.html . Accessed April 9, 2019
- 2 Gilbert JW, Wolpin B, Clancy T. , et al. Borderline resectable pancreatic cancer: conceptual evolution and current approach to image-based classification. Ann Oncol 2017; 28 (09) 2067-2076
- 3 Hammel P, Huguet F, van Laethem JL. , et al; LAP07 Trial Group. Effect of chemoradiotherapy vs chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib: the LAP07 randomized clinical trial. JAMA 2016; 315 (17) 1844-1853
- 4 Rossi ML, Rehman AA, Gondi CS. Therapeutic options for the management of pancreatic cancer. World J Gastroenterol 2014; 20 (32) 11142-11159
- 5 Neoptolemos JP, Stocken DD, Friess H. , et al; European Study Group for Pancreatic Cancer. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004; 350 (12) 1200-1210
- 6 Oettle H, Post S, Neuhaus P. , et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 2007; 297 (03) 267-277
- 7 Regine WF, Winter KA, Abrams RA. , et al. Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial. JAMA 2008; 299 (09) 1019-1026
- 8 Burris III HA, Moore MJ, Andersen J. , et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 1997; 15 (06) 2403-2413
- 9 Conroy T, Desseigne F, Ychou M. , et al; Groupe Tumeurs Digestives of Unicancer; PRODIGE Intergroup. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 2011; 364 (19) 1817-1825
- 10 Von Hoff DD, Ervin T, Arena FP. , et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 2013; 369 (18) 1691-1703
- 11 D'Onofrio M, Barbi E, Girelli R. , et al. Radiofrequency ablation of locally advanced pancreatic adenocarcinoma: an overview. World J Gastroenterol 2010; 16 (28) 3478-3483
- 12 Varadhachary GR, Tamm EP, Abbruzzese JL. , et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 2006; 13 (08) 1035-1046
- 13 de Liguori Carino N, O'Reilly DA, Siriwardena AK. , et al. Irreversible Electroporation in pancreatic ductal adenocarcinoma: Is there a role in conjunction with conventional treatment?. Eur J Surg Oncol 2018; 44 (10) 1486-1493
- 14 Pezzilli R, Serra C, Ricci C. , et al. Radiofrequency ablation for advanced ductal pancreatic carcinoma: is this approach beneficial for our patients? A systematic review. Pancreas 2011; 40 (01) 163-165
- 15 Rubinsky B. Irreversible electroporation in medicine. Technol Cancer Res Treat 2007; 6 (04) 255-260
- 16 Lee EW, Thai S, Kee ST. Irreversible electroporation: a novel image-guided cancer therapy. Gut Liver 2010; 4 (Suppl. 01) S99-S104
- 17 Bower M, Sherwood L, Li Y, Martin R. Irreversible electroporation of the pancreas: definitive local therapy without systemic effects. J Surg Oncol 2011; 104 (01) 22-28
- 18 Rashid MF, Hecht EM, Steinman JA, Kluger MD. Irreversible electroporation of pancreatic adenocarcinoma: a primer for the radiologist. Abdom Radiol (NY) 2018; 43 (02) 457-466
- 19 Martin II RC, McFarland K, Ellis S, Velanovich V. Irreversible electroporation therapy in the management of locally advanced pancreatic adenocarcinoma. J Am Coll Surg 2012; 215 (03) 361-369
- 20 Moris D, Machairas N, Tsilimigras DI. , et al. Systematic review of surgical and percutaneous irreversible electroporation in the treatment of locally advanced pancreatic cancer. Ann Surg Oncol 2019; 26 (06) 1657-1668
- 21 Scheffer HJ, Vroomen LG, de Jong MC. , et al. Ablation of locally advanced pancreatic cancer with percutaneous irreversible electroporation: results of the phase I/II PANFIRE study. Radiology 2017; 282 (02) 585-597
- 22 Huang KW, Yang PC, Pua U. , et al. The efficacy of combination of induction chemotherapy and irreversible electroporation ablation for patients with locally advanced pancreatic adenocarcinoma. J Surg Oncol 2018; 118 (01) 31-36
- 23 Narayanan G, Hosein PJ, Beulaygue IC. , et al. Percutaneous image-guided irreversible elecroporation for treatment of locally advanced pancreatic adenocarcinoma. J Vasc Interv Radiol 2017; 28: 342-348
- 24 Akinwande O, Ahmad SS, Van Meter T, Schulz B, Martin RC. CT findings of patients treated with irreversible electroporation for locally advanced pancreatic cancer. J Oncol 2015; 2015: 680319
- 25 Katz MH, Fleming JB, Bhosale P. , et al. Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer 2012; 118 (23) 5749-5756
- 26 Martin II RC, McFarland K, Ellis S, Velanovich V. Irreversible electroporation in locally advanced pancreatic cancer: potential improved overall survival. Ann Surg Oncol 2013; 20 (Suppl. 03) S443-S449
- 27 Martin II RC, Kwon D, Chalikonda S. , et al. Treatment of 200 locally advanced (stage III) pancreatic adenocarcinoma patients with irreversible electroporation: safety and efficacy. Ann Surg 2015; 262 (03) 486-494 , discussion 492–494
- 28 Holland MM, Bhutiani N, Kruse EJ. , et al. A prospective, multi-institution assessment of irreversible electroporation for treatment of locally advanced pancreatic adenocarcinoma: initial outcomes from the AHPBA pancreatic registry. HPB (Oxford) 2019 Doi: 10.1016/j.hpb.2018.12.004. [Epub ahead of print]
- 29 Vogel JA, Rombouts SJ, de Rooij T. , et al. Induction chemotherapy followed by resection or irreversible electroporation in locally advanced pancreatic cancer (IMPALA): a prospective cohort study. Ann Surg Oncol 2017; 24 (09) 2734-2743
- 30 Young R, Mainwaring P, Clingan P. , et al. nab-Paclitaxel plus gemcitabine in metastatic pancreatic adenocarcinoma: Australian subset analyses of the phase III MPACT trial. Asia Pac J Clin Oncol 2018; 14 (05) e325-e331
- 31 Khan W, Sullivan KL, McCann JW. , et al. Moxifloxacin prophylaxis for chemoembolization or embolization in patients with previous biliary interventions: a pilot study. AJR Am J Roentgenol 2011; 197 (02) W343-5
- 32 Kim AY, Frantz S, Brower J, Akhter N. Radioembolization with Yttrium-90 microspheres for the treatment of liver metastases of pancreatic adenocarcinoma: a multicenter analysis. J Vasc Interv Radiol 2019; 30 (03) 298-304.e2
- 33 Brown DB, Narayanan G. Interventional radiology and the pancreatic cancer patient. Cancer J 2012; 18 (06) 591-601
- 34 Saad WE, Wallace MJ, Wojak JC, Kundu S, Cardella JF. Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol 2010; 21 (06) 789-795
- 35 Tempero MA, Malafa MP, Al-Hawary M. , et al. Pancreatic adenocarcinoma, version 2.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2017; 15 (08) 1028-1061
- 36 Shibata T, Ebata T, Fujita K. , et al. Optimal dose of gemcitabine for the treatment of biliary tract or pancreatic cancer in patients with liver dysfunction. Cancer Sci 2016; 107 (02) 168-172
- 37 Thornton RH, Ulrich R, Hsu M. , et al. Outcomes of patients undergoing percutaneous biliary drainage to reduce bilirubin for administration of chemotherapy. J Vasc Interv Radiol 2012; 23 (01) 89-95
- 38 Eklund JW, Trifilio S, Mulcahy MF. Chemotherapy dosing in the setting of liver dysfunction. Oncology (Williston Park) 2005; 19 (08) 1057-1063 , discussion 1063–1064, 1069
- 39 Lammer J, Hausegger KA, Flückiger F. , et al. Common bile duct obstruction due to malignancy: treatment with plastic versus metal stents. Radiology 1996; 201 (01) 167-172
- 40 Bezzi M, Zolovkins A, Cantisani V. , et al. New ePTFE/FEP-covered stent in the palliative treatment of malignant biliary obstruction. J Vasc Interv Radiol 2002; 13 (06) 581-589
- 41 Isayama H, Komatsu Y, Tsujino T. , et al. A prospective randomised study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut 2004; 53 (05) 729-734
- 42 Krokidis M, Fanelli F, Orgera G. , et al. Percutaneous palliation of pancreatic head cancer: randomized comparison of ePTFE/FEP-covered versus uncovered nitinol biliary stents. Cardiovasc Intervent Radiol 2011; 34 (02) 352-361
- 43 Telford JJ, Carr-Locke DL, Baron TH. , et al. A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction. Gastrointest Endosc 2010; 72 (05) 907-914
- 44 Venkatanarasimha N, Damodharan K, Gogna A. , et al. Diagnosis and management of complications from percutaneous biliary tract interventions-erratum. Radiographics 2017; 37 (03) 1004
- 45 Fidelman N, Bloom AI, Kerlan Jr RK. , et al. Hepatic arterial injuries after percutaneous biliary interventions in the era of laparoscopic surgery and liver transplantation: experience with 930 patients. Radiology 2008; 247 (03) 880-886
- 46 Wente MN, Veit JA, Bassi C. , et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 2007; 142 (01) 20-25
- 47 Cronin CG, Gervais DA, Castillo CF-D, Mueller PR, Arellano RS. Interventional radiology in the management of abdominal collections after distal pancreatectomy: a retrospective review. AJR Am J Roentgenol 2011; 197 (01) 241-246
- 48 Bassi C, Dervenis C, Butturini G. , et al; International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005; 138 (01) 8-13
- 49 Baker TA, Aaron JM, Borge M, Pierce K, Shoup M, Aranha GV. Role of interventional radiology in the management of complications after pancreaticoduodenectomy. Am J Surg 2008; 195 (03) 386-390 , discussion 390
- 50 Sohn TA, Yeo CJ, Cameron JL. , et al. Pancreaticoduodenectomy: role of interventional radiologists in managing patients and complications. J Gastrointest Surg 2003; 7 (02) 209-219
- 51 de Castro SM, Kuhlmann KF, Busch OR. , et al. Incidence and management of biliary leakage after hepaticojejunostomy. J Gastrointest Surg 2005; 9 (08) 1163-1171 , discussion 1171–1173
- 52 Koch M, Garden OJ, Padbury R. , et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 2011; 149 (05) 680-688
- 53 Puppala S, Patel J, McPherson S, Nicholson A, Kessel D. Hemorrhagic complications after Whipple surgery: imaging and radiologic intervention. AJR Am J Roentgenol 2011; 196 (01) 192-197
- 54 Yekebas EF, Wolfram L, Cataldegirmen G. , et al. Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1669 consecutive pancreatic resections. Ann Surg 2007; 246 (02) 269-280
- 55 Tien YW, Wu YM, Liu KL, Ho CM, Lee PH. Angiography is indicated for every sentinel bleed after pancreaticoduodenectomy. Ann Surg Oncol 2008; 15 (07) 1855-1861
- 56 Wallace MJ, Choi E, McRae S, Madoff DC, Ahrar K, Pisters P. Superior mesenteric artery pseudoaneurysm following pancreaticoduodenectomy: management by endovascular stent-graft placement and transluminal thrombin injection. Cardiovasc Intervent Radiol 2007; 30 (03) 518-522
- 57 Sanjay P, Kellner M, Tait IS. The role of interventional radiology in the management of surgical complications after pancreatoduodenectomy. HPB (Oxford) 2012; 14 (12) 812-817