- Last Updated: July 11, 2017
More than 45,000 new cases of pancreatic cancer are diagnosed each year. It is difficult to detect at early stages, in part because the pancreas is a deep organ, physicians do not feel early tumors, and blood tests are not available for early detection. Thus, more than 80% of the time pancreatic cancer is diagnosed, it has already spread to be unresectable. It has the third-highest fatality rate of all cancers, and the 5 year survival rate is only 8%.
Therapeutic options for pancreatic cancer include surgery, radiation, chemotherapy, ablative techniques, and embolization. The precise treatment regimen depends on location and stage of the cancer. Survival rates following conventional therapies are 12% to 14% for earlier-stage cancers and 1% to 5% for later stages.
Surgery is the only potentially curative treatment for pancreatic cancer. However, it is one of the most difficult operations, both for the surgeon and the patient, so it is performed primarily when imaging suggests that the entire tumor can be removed. One type of surgery is the Whipple procedure, which removes the head and sometimes the body of the pancreas, along with the gall bladder, nearby lymph nodes, and parts of the small intestine, common bile duct, and stomach. Another type of surgery is distal pancreatectomy, which removes only the tail and part of the body of the pancreas.
In many cases, surgeons begin the operation with the intent to cure but discover that it is not possible. In those cases, the surgeon may continue the procedure to relieve symptoms and prevent complications such as blockages in the bile duct or intestinal tract.
Patients treated with surgery tend to survive longer than those who are not. However, only one in six patients with pancreatic cancer receive surgery.
Radiation therapy involves focusing an external beam of high-energy X-rays or particles to kill cancer cells. Radiation therapy does contains risks for secondary malignancies and for those with poor wound healing. It is also still under evaluation in clinical trials for pancreatic cancer.
Chemotherapeutic drugs, which kill cancer cells, are given by mouth or by injection. For resectable cancers, chemotherapy may delay recurrence for as long as six months. For advanced pancreatic cancer, chemotherapy with gemcitabine has been the standard treatment. In general, chemotherapy does not work well for pancreatic cancer.
Ablative techniques can be used for local tissue destruction. With these techniques, a probe or needle can be inserted into the tumor to thermally destroy tissue around the needle tip and reduce tumor symptoms. Radiofrequency waves or microwaves are passed through the probe to heat and destroy the tissue. Alternatively, liquid nitrogen or liquid carbon dioxide can be passed through the probe to freeze and destroy it.
Embolization kills the tumor by blocking its blood supply. A catheter is inserted, usually through an artery in the groin area, and threaded into the artery feeding the tumor. Plain or radioactive beads are injected to block the artery. Sometimes, chemotherapy is injected before the beads.
Focused Ultrasound Therapy
Focused ultrasound has the potential to offer a non-invasive ablative technique for palliation in patients with pancreatic cancer. Guided by ultrasound or magnetic resonance imaging, the physician directs a focused beam of acoustic energy toward the cancer. This beam heats and destroys the cancerous tissue without damaging nearby tissues or structures.
As a potentially non-invasive technique that does not rely on ionizing radiation, focused ultrasound may offer benefits including:
- shorter recovery time
- more precise targeting of tumor and metastases, resulting in lower risk for complications
- the procedure can be done repeatedly
However, not all patients will be suitable for focused ultrasound treatment, as in some cases where the bowel blocks pathway of the beam. There is also potential for damage to non-targeted tissue, such as the skin.
Pre-clinical research with focused ultrasound can enable a better understanding of pathologic process and yield improved treatments of the underlying disease by delivering therapeutic agents, enhancing agent affinity, or augmenting the immune response.
Studies include work at University of Utah looking at the best method of drug delivery, including mechanical, thermal and ultrasound activated perfluorocarbon nanoemulsions as options.
A Foundation-funded preclinical study at the MD Anderson Cancer Center looked at the ability of gold nanoparticles contained in liposomes to penetrate the pancreatic tumor environment and release the nanoparticles after focused ultrasound treatment. The results support the ability of the gold nanoparticles to be released by focused ultrasound deep in the tumor environment, which was more pronounced after hyperthermia. The benefit of the gold nanoparticles is their ability to enhance subsequent radiation therapy.
Work at the University of Washington found that in mice with pancreatic cancer, an increased amount of doxorubicin uptake occurred in the setting of focused ultrasound generated hyperthermia compared to controls.
The Institute of Cancer Research in London is comparing several aspects of immunotherapy in pre-clinical studies of pancreatic cancer. They are comparing the tumor volume, survival, and levels of cytotoxic T cells from mice treated with focused ultrasound, focused ultrasound plus immune checkpoint inhibitors, or focused ultrasound degradation of the tumor microenvironment in an effort to identify the optimal approach.
There has been anecdotal evidence that use of focused ultrasound inside the main tumor has resulted in stimulation of the immune system, resulting in significant reduction in lymph nodes outside of the treatment region. This benefit has been seen frequently enough to ensure that it is a valid observation, yet efforts to demonstrate it consistently have been elusive. There is considerable work aimed at taking this beneficial effect and making it a more reliable part of the treatment plan.
Additional focused ultrasound impacts may produce results in patients with pancreatic cancer. The mechanical effect of hyperthermia may help with chemotherapy binding, and sonodynamic therapy may also assist in the local impact of chemotherapeutic agents. Focused ultrasound can also be very helpful in reduction in the pain from pancreatic cancer, either as part of an overall plan for tumor control or as tool used exclusively for pain control. These approaches are encouraging, but still very early in adoption, so ongoing work continues to identify the optimal use of these techniques.
A clinical trial at the University of Roma La Sapienza in Italy has expanded access to treatment in a study exploring the feasibility and clinical performance of focused ultrasound in pain palliation and tumor control. More information about this trial can be found at http://clinicaltrials.gov/show/NCT01786850.
The Focused Ultrasound Foundation is working with leading sites to implement a registry to capture data from pancreatic cancer patients to help guide future decisions about optimal clinical care, safety and regulatory factors, and reimbursement concerns. The goal of this registry is to capture early data to expedite the availability of focused ultrasound improvements for patient care as soon as possible.
Regulatory Approval and Reimbursement
The Model JC system manufactured by Chongqing Haifu has been approved in Europe for palliative treatment in patients with pancreatic cancer.
Focused ultrasound treatment for patients with pancreatic cancer is not universally reimbursed by medical insurers.
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