title: Systematic review of novel ablative methods in locally advanced pancreatic cancer.
abstract: Unresectable locally advanced pancreatic cancer with or without metastatic disease is associated with a very poor prognosis. Current standard therapy is limited to chemotherapy or chemoradiotherapy. Few regimens have been shown to have a substantial survival advantage and novel treatment strategies are urgently needed. Thermal and laser based ablative techniques are widely used in many solid organ malignancies. Initial studies in the pancreas were associated with significant morbidity and mortality, which limited widespread adoption. Modifications to the various applications, in particular combining the techniques with high quality imaging such as computed tomography and intraoperative or endoscopic ultrasound has enabled real time treatment monitoring and significant improvements in safety. We conducted a systematic review of the literature up to October 2013. Initial studies suggest that ablative therapies may confer an additional survival benefit over best supportive care but randomised studies are required to validate these findings.
authors.affiliation: Margaret G Keane, Stephen P Pereira, Institute for Liver and Digestive Health, University College London, Royal Free Campus, London NW3 2PF, United Kingdom.
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Keane
authors.affiliation: Margaret G Keane, Stephen P Pereira, Institute for Liver and Digestive Health, University College London, Royal Free Campus, London NW3 2PF, United Kingdom.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Bramis
authors.affiliation: Margaret G Keane, Stephen P Pereira, Institute for Liver and Digestive Health, University College London, Royal Free Campus, London NW3 2PF, United Kingdom.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Pereira
authors.affiliation: Margaret G Keane, Stephen P Pereira, Institute for Liver and Digestive Health, University College London, Royal Free Campus, London NW3 2PF, United Kingdom.
authors.forename: Giuseppe K
authors.initials: GK
authors.lastname: Fusai
mesh_terms: D055011:Ablation Techniques; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D003452:Cryosurgery; D018274:Electroporation; D057086:High-Intensity Focused Ultrasound Ablation; D006801:Humans; D053685:Laser Therapy; D008872:Microwaves / Q000627:therapeutic use; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cryoablation; High frequency focused ultrasound; Irreversible electroporation; Microwave ablation; Pancreatic cancer; Photodynamic therapy; Radiofrequency ablation