Microwave Ablation with Percutaneous Approach for the Treatment of Pancreatic Adenocarcinoma.

Pancreatic adenocarcinoma, characterized by a late presentation
and by high aggressiveness, is one of the most
lethal human cancers and currently the fifth most common
cause of cancer-related death in men [1]. Only 10% of the
tumors are confined to the pancreas at the time of presentation,
30–40% are locally advanced, and 50% have distant
metastases [1, 2]. Only approximately 20% of pancreatic
cancers are found to be resectable at the time of presentation.
Surgical resection is the only potentially curative
treatment for pancreatic cancer [2].
Some palliative therapeutic modalities have been
applied in treatment of unresectable locally advanced
pancreatic carcinoma, such as chemotherapy and chemoradiation
[3]. In a few patients, thermal ablative techniques,
such as radiofrequency ablation (RFA) and microwave
ablation (MWA), have been reported, especially in association
with surgery [4, 5].
Date RS [6] reviewed the results of local ablative therapies
for the treatment of pancreatic cancer; photodynamic
therapy (PDT), high-intensity ultrasound (HIFU), cryoablation,
and RFA may have role in ablation of pancreatic
tumors. Wu et al. [7] reported encouraging results on the
feasibility of HIFU ablation of pancreas tumor, but they
excluded patients with carcinoma located in the head to
avoid damage of the biliary duct. Photodynamic therapy
has major disadvantages of organizational and technical
difficulties in setting up the treatments and potential side
effects, such as skin photosensitivity reaction [8]. Matsui
et al. [9] performed laparotomy and radiofrequency heating
in 20 patients with unresectable pancreatic carcinomas.
They have reported an intraperitoneal abscess in one
patient who died of septic shock.
Potential benefits of these techniques include treatment of
patients who are not surgical candidates and reduced morbidity
compared with surgery. Ablation with microwave has
several intrinsic advantages over RFA, including the capability
to generate very high tissue temperature, less intraprocedural
pain, larger coagulation zones, less sensitivity to
tissue type and charring, improved performance near blood
vessels, and no requirement of ground pads [10–12].
Recently, this technique has been proposed in different
organs, such as liver, lung, and kidney [10]. However, only
few cases regarding the use of MWA in pancreatic cancer
have been published and they were performed under laparotomy
represents the first pancreatic head cancer with the percutaneous
approach treated with MWA.