Pancreatic cancer is a disease in which malignant cancer cells form in the tissues of the pancreas. Pancreatic cancer and palliative care understanding pancreatic cancer. Its important to think about the benefits of each treatment option compared to the possible risks and side effects. Palliative surgery may be done if tests show that the cancer is too widespread to. After an early tumour progression on firstline chemotherapy with cisplatin and gemcitabine, even though it was badly tolerated, he was treated with a combination of systemic modified folfiri and highintensity focused ultrasound hifu on the pancreatic mass. It has been reported to have a high capacity to infiltrate tissues and a strong tendency to metastasise. Based on this result, we can conclude that 81% of patients may expect to have pain relief. Clinical application of highintensity focused ultrasound. Pancreatic cancer, high intensity focused ultrasound, hifu, pain palliation, pain relief, noninvasive treatment, metaanalysis background pancreatic cancer incidence is increasing worldwide with 53070 new cases and 41780 deaths estimated in 2016, and is currently the fourth cause of cancer related death 1, 2. Jun, 2011 hifu has been first used for the palliative treatment of pancreatic cancer in an openlabel study in china in 251 patients with advanced pancreatic cancer tnm stages iiiv. Jul 08, 2019 hifu for palliative treatment of pancreatic cancer.
Current treatment options are focused on pancreatic cancer, and include. There were patients with stage iii, and 27 patients with stage iv disease. Pdf pancreatic cancer is under high mortality but has few effective treatment modalities. The benefit was most obvious in pdac patients treated with hifu plus riac and systemic chemotherapy. Jan 10, 2020 pancreatic cancer is the fourth leading cause of cancer deaths, being responsible for 7% of all cancer related deaths in both men and women. Early clinical experience using high intensity focused ultrasound for palliation of inoperable pancreatic cancer.
Studies assessing treatment in patients with pancreatic. Several preclinical and clinical studies have investigated the safety and efficacy of hifu for treating solid tumours, including pancreatic cancer. Typical diagnostic ultrasound transducers operate at the pressures of 0. Palliative treatment for advanced pancreatic cancer cancer. Highintensity focused ultrasound treatment for advanced. Supportive palliative care which focuses on comfort, quality of life and a patients total wellbeing can help. Successful palliative approach with highintensity focused. Hifu has been first used for the palliative treatment of pancreatic cancer in an openlabel study in china in 251 patients with advanced pancreatic cancer tnm stages iiiv. Hifu therapy utilizes mechanical energy in the form of a powerful ultrasound wave that is focused inside the body to induce thermal andor mechanical effects in tissue. Hifu is safe, effective, and feasible in pancreatic cancer patients. Treating pancreatic cancer, based on extent of the cancer. The most common type of pancreatic cancer occurs in the ducts that transport the pancreatic juices.
A metaanalysis of palliative treatment of pancreatic cancer. Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, emotional, cultural, social and spiritual needs. A report of hifu treatment in 251 patients with advanced pancreatic cancer, tnm stage iiiv, suggest that hifu treatment can reduce the size of pancreatic tumors without causing pancreatitis, and prolong survival. High intensity focused ultrasound hifu has emerged in recent years as a new noninvasive treatment for solid malignant tumors, including pancreatic cancer 1.
Palliative care is a mainstay of the treatment for patients with advanced pancreatic cancer. A variety of solid tumors have been tried on thousands of patients in the last fifteen years with great success. Concurrent chemotherapy and pulsed highintensity focused. Approximately 75% of all pancreatic carcinomas occur within the head or neck of the pancreas, 1520% occur in the body of the pancreas, and 510% occur in the tail. High intensity focused ultrasound treatment for patients with local advanced pancreatic cancer. The therapy was divided into several sessions such that each treatment session was approximately 60 minutes. The random effects estimate of proportion of patients with pain reduction was 0. The principle, mechanism, and clinical outcome of hifu were introduced. Experimentally, a palliative effect was found in cases of advanced pancreatic cancer.
High intensity focused ultrasound hifu cancer research uk. High intensity focused ultrasound hifu is a novel noninvasive modality for ablation of various solid tumors including uterine fibroids, prostate cancer, hepatic, renal, breast and pancreatic tumors. A metaanalysis of palliative treatment of pancreatic cancer with high. Pancreatic cancer is under high mortality but has few e ective treatment modalities.
Celiac plexus neurolysis can be performed in patients who have severe intractable pain that is poorly controlled on opioids. A metaanalysis of palliative treatment of pancreatic. Pancreatic cancer begins in the pancreas, an organ located deep in the abdomen behind the stomach. Quality of life following highintensity focused ultrasound for the treatment of localized prostate cancer.
Other than improving global qol, it can also improve the tolerability of chemotherapy, the compliance of the patient to antitumour therapy thereby making systemic chemotherapy more. Because some of the research published in this area was not written in english, it does not appear in pubmed. A metaanalysis of palliative treatment of pancreatic cancer with high intensity focused ultrasound. The most common palliative locoregional treatment used in pancreatic cancer is external radiotherapy rt. Preliminary studies suggest that hifu may be useful for the palliative therapy of cancer related pain in patients with.
Request pdf on researchgate hifu for palliative treatment of pancreatic cancer high intensity focused ultrasound hifu is a novel. Among 639 patients treated with hifu, 567 complained of pancreatic pain before the treatment. Multimodality treatment by folfox plus hifu in a case of. Therapeutic effects of microbubbles added to combined high. Hifu is being studied in the treatment of prostate cancer and some other types of cancer and other diseases. Most patients with pancreatic cancer present as inoperable diseases because of the involvement of major vasculature resulting in high surgical risk. Hifu for palliative treatment of pancreatic cancer request pdf. Multiple preclinical and nonrandomized clinical trials. Since this was only an observational study, no meaningful conclusion can be made regarding the utility of hifu therapy on survival. Feasibility of usguided highintensity focused ultrasound treatment in patients with advanced pancreatic cancer.
All variants of hifu high intensity focused ultrasound, pancreatic pancreas, cancer carcinoma, palliation palliative were searched. Prognosis is poor with a fivemonth median survival time since diagnosis and treatment. Palliative care and pancreatic cancer get palliative care. The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. Hifu is now applied for pancreatic cancer treatment. Clinical application of highintensity focused ultrasound in.
Key points usguided hifu is feasible and safe for patients with unresectable pancreatic cancer. Hifu for palliative treatment of pancreatic cancer ncbi. Hifu for palliative treatment of pancreatic cancer high intensity focused ultrasound hifu is a novel noninvasive modality for ablation of various solid tumors including uterine broids, prostate cancer, hepatic, renal, breast and pancreatic tumors. In contrast, it is palliative for those with advanced cancer, impeding tumor.
A variety of solid tumors have been tried on thousands of patients in the last een years with great success. Khokhlova t d, hwang j h 2016 hifu for palliative treatment of pancreatic cancer. Highintensity focused ultrasound hifu is becoming an emerging approach of noninvasively ablating solid tumor in clinics. Inoperable pancreatic adenocarcinoma rendered complete. Hifu is safe, effective, and feasible in pancreatic cancer. In contrast, it is palliative for those with advanced.
To evaluate the painalleviating action, feasibility and efficacy of high intensity focused ultrasound hifu for palliation of inoperable pancreatic cancer in humans. Analgesic effect of high intensity focused ultrasound. Pdf highintensity focused ultrasound treatment for advanced. It also produces enzymes to help the body digest fats, carbohydrates and proteins. Several features of this site will not function whilst javascript is disabled. Hifu can considerably reduce tumour volume and cancer. High intensity focused ultrasound treatment for patients with. Hifu for palliative treatment of pancreatic cancer europe. It is worth mentioning here that ultrasound absorption in tissue increases nearly linearly with ultrasound frequency.
Highintensity focused ultrasound for pain management in patients. Highintensity focused ultrasound hifu in hifu, highintensity us waves are bundled by special transducers and focused on a target point within the human body so that coagulation necrosis and tissue destruction are induced in the target tissue. Figure 1 grayscale changes in treated pancreatic cancer tissue on realtime us. The options described in this section are generally considered palliative treatment. High intensity focused ultrasound hifu is a novel noninvasive modality for ablation of various solid tumors including uterine fibroids, prostate. Hifu therapy resulted in significant pain relief in 84% of the patients. Highintensity focused ultrasound hifu is an emerging. An early clinical study concluded that hifu was safe and feasible for the treatment of advanced pancreatic cancer with a median overall survival os of 11. Anaplastic pancreatic carcinoma apc is a highly malignant cancer arising from epithelial lineage. Highintensity focused ultrasound as an effective and safe treatment for palliation of pain related to pancreatic cancer a b s t r a c t. Cancer with longterm survival in highintensity focused ultrasound hifu. Sporadic literature data exist on intraarterial chemotherapy 8.
Treatment of prostate enlargement benign prostatic hyperplasia by hifu from inside the intestine transrectal has turned out to be unsuccessful. Scott sj, adams ms, salgaonkar v, sommer fg, diederich cj. Ce approval has been given for palliative treatment of bone metastasis. Journal of therapeutic ultrasound 2017 volume 1 pages 59. The pancreas releases hormones called insulin and glucagon to help the body process sugar. Request pdf hifu for palliative treatment of pancreatic cancer high intensity focused ultrasound hifu is a novel noninvasive modality for ablation of various solid tumors including uterine. A procedure in which highenergy sound waves are aimed directly at an area of abnormal cells or tissue in the body.
The principle, mechanism, and clinical outcome of hifu were introduced first. Cgmed81 high intensity focused ultrasound hifu for. The use of hifu for the palliative treatment of pancreatic cancer may be useful in patients that develop symptoms that would benefit from local tumor control. Hifu therapy utilizes mechanical energy in the form of a powerful ultrasound wave that is focused inside the body to induce thermal andor. Highintensity focused ultrasound treatment of latestage. Context pancreatic cancer is one of the most aggressive malignant diseases in which the survival rate has not improved in the past 40 years. Hifu is now applied for pancreatic cancer treatment in china. Substantial tumorrelated pain reduction was achieved in most cases a. Pancreatic cancer treatment what is pancreatic cancer. Full text hifu is safe, effective, and feasible in pancreatic cancer. Highintensity focused ultrasound hifu for pancreatic. Pancreatic cancer is under high mortality but has few effective treatment modalities. Pancreatic cancer remains to be a challenge for the health care providers in the world.
Gemcitabine as the main drug of chemotherapy cannot relieve pain and so it is not useful to make the patients live a better life, palliative treatment of pancreatic cancer is a big problem in medical science. Early clinical experience using high intensity focused. However, the results of chemotherapy are still disappointing, showing pancreatic cancer. The first report 5 of hifu treatment case in pancreatic cancer used model fepby01 machine. Wu f 2006 extracorporeal high intensity focused ultrasound in the treatment of patients with solid malignancy. After hifu, 459 patients experienced a partial or complete pain relief table 2. For the past three decades, we have made few breakthroughs for managing this malignant disease. All 3022 clinical cases of hifu treatment for the advanced pancreatic cancer alone. New guidelines recommend palliative care early, with treatment. In order to relieve the symptoms and provide better quality of life, palliative. Hifu for palliative treatment of pancreatic cancer. Advances of high intensity focused ultrasound hifu for. Highintensity focused ultrasound hifu is a novel therapeutic modality used successfully in preclinical trials that allows the nonsurgical treatment of various benign and malignant solid tumors, including unresectable pancreatic cancer horner et al. Use of rt in metastatic disease is required for pain control with a palliative dose of 30 gy.
Pancreatic cancer treatment pdqpatient version national. Palliative treatment for advanced pancreatic cancer. Multiple preclinical and nonrandomized clinical trials have been performed to evaluate the safety and efficacy of hifu for palliative treatment of pancreatic tumors. A variety of solid tumors have been tried on thousands of. We report a case of a 74yearold man with a metastatic anaplastic pancreatic carcinoma apc. Pdf highintensity focused ultrasound treatment for.
All variants of hifuhigh intensity focused ultrasound, pancreaticpancreas, cancercarcinoma, palliationpalliative were searched. For the management of abnormal cervical screening tests and cancer precursors. The thermal hypothesis of the mechanism of ultrasonic focal destruction in organized tissues. Hifu application in the palliative treatment of pancreatic cancer could be useful in patients with symptoms that would benefit from local tumor restriction.
The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. High intensity focused ultrasound other treatments cancer. Forty patients with advanced pancreatic cancer were treated with hifu. Since the late 1990s, highintensity focused ultrasound hifu has been used widely in china and korea and is now recommended by the us national institutes of health 20 as an alternative treatment for unresectable pdac patients. Focused ultrasound for pancreatic cancer pdf, july 2019. This study was to evaluate the efficacy and safety of high intensity focused ultrasound hifu in pain palliation of advanced unresectable pancreatic cancer. Case report a fiftyoneyearold male patient with inoperable metastatic pancreatic cancer and low response to chemotherapy with gemcitabine as single therapy underwent palliative high intensity focused ultrasound hifu ablation. Theoretical investigation of transgastric and intraductal approaches for ultrasoundbased thermal therapy of the pancreas. Pancreatic cancer treatment options depend on extent of disease and may include surgery, radiation, chemotherapy, chemoradiation, and supportive care. Cantore m et al phase ii study of hepatic intraarterial epirubicin and cisplatin, with systemic 5fluorouracil in patients with unresectable biliary tract tumors cancer 7 7 doi. Influence of high intensity focused ultrasound hifu treatment to the pancreatic function in pancreatic cancer patients. Apr 05, 2020 multiple preclinical and nonrandomized clinical trials. Hifu therapy has been undergoing rapid development over the last decade such that several clinical hifu devices are now commercially available.
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