Radiofrequency Ablation of Pancreatic Mass
Stage III pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, and no gold standard treatment has been established so far. Radiofrequency ablation (RFA) is a new treatment option for locally advanced pancreatic cancer (LAPC), but its application
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Radiofrequency Ablation of Pancreatic Mass Roberto Girelli, Frigerio Isabella, Alessandro Giardino, Paolo Regi, Filippo Scopelliti, and Giovanni Butturini
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Introduction
Pancreatic ductal carcinoma is the fourth cause of death for cancer in Western countries. The high mortality rate is due to the incidence of metastatic or unresectable disease at the time of diagnosis because of the lack of specific symptoms. Advanced pancreatic cancer has a poor prognosis with a median survival range of 9–15 months for locally advanced pancreatic cancer and 6 months for metastatic disease [1]. Although the associated increase in risk is small, the development of pancreatic cancer is strictly linked to cigarette smoking [2–4]. An increased body mass index is also associated with an increased risk [5–7] as well as occupational exposure to chemicals, such as beta-naphthylamine and benzidine [8]. A familial history of PDAC or recent onset of diabetes may play a key role and requires clinical surveillance for these subjects [3, 9–13]. An excess of pancreatic cancer is also seen in families harboring breast cancer susceptibility gene 2 mutations (BRCA2) [14, 15]. Specific mutations in the PALB2 gene have recently been identified as possibly increasing susceptibility for pancreatic cancer [16]. In 70 % of cases, the tumor is located in the pancreatic head, and symptoms are usually related to the involvement of surrounding structures: the duodenum and common bile duct. For tumors of the body and tail, the diagnosis can be late due to nonspecific symptoms (back pain, abdominal discomfort, dyspepsia), particularly when the disease is advanced and the mass has enough room to expand. Less than 20 % of cases are resectable at the time of diagnosis, and it is well known that radical (R0) resection is the only chance to improve long-term survival. However, even under
R. Girelli (*) Hepato-Pancreato-Biliary Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy e-mail: [email protected] F. Isabella • A. Giardino • P. Regi • F. Scopelliti • G. Butturini Pederzoli Hospital, Peschiera del Garda, Verona, Italy © Springer International Publishing Switzerland 2017 R. Conigliaro, M. Frazzoni (eds.), Diagnosis and Endoscopic Management of Digestive Diseases, DOI 10.1007/978-3-319-42358-6_3
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optimal conditions, the median survival of these patients ranges from 15 to 19 months, and the 5-year survival rate is approximately 20 % [17]. The three possible scenarios at time of diagnosis are the following: • The tumor is small and “well located,” and surgical resection is possible (20 % of cases) with high chance of clear margins. Negative margin status (R0 resection), tumor DNA content, tumor size, and the absence of lymph node metastases are the strongest prognostic indicators for long-term patient survival [18–21]. The high rate of metastatic recurrence after radical resection of early-stage disease suggests that pancreatic adenocarcinoma is a systemic disease in most patients by the time of clinical presenta
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