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    Home > Active Ingredient News > Digestive System Information > Interventional therapy for clinically necessary advanced pancreatic cancer

    Interventional therapy for clinically necessary advanced pancreatic cancer

    • Last Update: 2022-08-15
    • Source: Internet
    • Author: User
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    Pancreatic cancer is one of the common digestive system malignancies, ranking 14th among the most common cancers and the seventh leading cause of cancer death worldwi.
    Pancreatic cancer is applicable to the TNM staging of AJ.
    In clinical practice, whether surgical resection is possible is used to stage pancreatic cancer: resectable pancreatic cancer, borderline resectable pancreatic cancer (which may or may not be surgically resectable), locally advanced pancreatic cancer (unresectabl.
    surgical resection), metastatic/advanced pancreatic cancer (unresectabl.
    Less than 15% of all pancreatic cancers diagnosed are operable, and more than 85% are unresectab.
    In this guideline, advanced pancreatic cancer refers to pancreatic ductal cell carcinoma that has local and/or distant metastases and cannot be surgically removed, and is at stage III or higher of T4N0MTable 1 TNM and pathological staging system (AJCC eighth edition) Currently the most effective method for pancreatic cancer is still radical resecti.
    According to imaging evaluation, pancreatic cancer is divided into: (1) resectable pancreatic cancer, (2) junctional resectable Pancreatic cancer, (3) locally advanced pancreatic cancer, (4) pancreatic cancer with distant metastas.
    For advanced pancreatic cancer, the traditional treatment methods are mainly intravenous chemotherapy and radiothera.
    In recent years, the interventional diagnosis and treatment of advanced pancreatic cancer has become more and more extensi.
    Related concepts of interventional diagnosis and treatment of advanced pancreatic cancer Percutaneous biopsy of the pancreas: Percutaneous biopsy of the pancreas is performed using an imaging device (ultrasound, CT or MRI guided) to puncture the part of the pancreatic lesion with a fine needle to extract some cells or tissu.
    Pathological examination to confirm the diagnos.
    Sufficient and high-quality histological and cytological small samples can be obtained through percutaneous puncture, and accurate histological typing and molecular detection can be performed for patients with pancreatic cancer, so as to guide diagnosis and treatme.
    Intra-arterial infusion chemoembolization: intra-arterial infusion chemotherapy (TAI) refers to the intra-arterial insertion of a catheter or microcatheter into the main blood supply artery (such as gastroduodenal artery, e.
    ) of pancreatic cancer lesions and metastas.
    Corresponding chemotherapeutic drugs and their regimens determined by the data are the treatment methods of instilling drugs into tumor tissue through catheters within a certain period of ti.
    Percutaneous 125I seed implantation: Percutaneous 125I seed implantation refers to the use of CT scanning and other imaging positioning techniques under local anesthesia to determine the target volume and the number of seed implants based on the simulated internal radiation therapy system (TP.
    Direct puncture is a method of implanting 125I seeds into pancreatic cancer and metastatic lesions to cause necrosis of tumor tissue cel.
    Percutaneous ablation: It refers to the in-situ inactivation of tumor cell necrosis through chemical or physical methods under the guidance of imagi.
    The principle is to inactivate tumor cells to the greatest extent and protect normal tissue structures to the greatest exte.
    According to the treatment principle, it is divided into two categories: chemical ablation and physical ablati.
    Indications of percutaneous pancreatic biopsy for advanced pancreatic cancer: pancreatic biopsy is suitable for solid pancreatic mass, cystic and solid pancreatic mass, suspected diffuse disease, e.
    , to determine the nature of pancreatic lesions, and to differentiate primary pancreatic cancer from metastasis cancere.
    Contraindications: severe bleeding tendency, acute pancreatitis, peritonitis, skin infection, poor cardiopulmonary function, massive ascites,e.
    TAI + transcatheter vascular embolization (TAE) for advanced pancreatic cancer For unresectable advanced pancreatic cancer, the local drug concentration of transarterial infusion chemotherapy is significantly higher than that of systemic intravenous chemotherapy, which can improve disease-related symptoms, prolong survival, and reduce pancreatic canc.
    Cancer liver metastases and the treatment of liver metastases have achieved better therapeutic effec.
    Indications: (1) Unresectable advanced pancreatic cancer; (2) Pancreatic cancer that has been treated ineffective by other non-surgical methods; (3) Pancreatic cancer with liver metastasis; (4) Postoperative recurrence of pancreatic canc.
    Contraindications: (1) Allergy to contrast agents; (2) Massive ascites, multiple metastases throughout the body; (3) Patients with systemic failure, obvious cachexia, ECOG score > 2 points, and multiple organ failure; ( 4) Patients with bleeding or coagulation disorders that cannot be corrected, and who have obvious bleeding tendency; (5) Patients with poor liver and kidney function, which exceed 5 times the normal reference value; (6) WBC<5×109/ L, platelets <50×109/L; the above (1) to (3) are absolute contraindications, and (4) to (6) are relative contraindicatio.
    Indications of percutaneous 125I seed implantation for advanced pancreatic cancer: (1) pancreatic cancer metastases and local metastatic lymph nodes; (2) expected survival > 3 months and cannot be surgically removed; (3) unwilling and (or ) patients who cannot receive radical surgery due to other concomitant diseases; (4) the expected survival period is less than 3 months, and this treatment can be carefully selected to relieve persistent upper abdominal and lower back pain; (5) residual lesions and residual lesions during pancreatic tumor resection (or) The location of the tumor bed; (6) The tumor decompression should be carefully selected if the largest diameter of the primary pancreatic tumor is more than 0 .
    Contraindications: (1) There is clear clinical evidence to prove that the pancreatic tumor has been widely metastasized; (2) Patients with multiple organ failure; (3) Patients with pancreatic malignant tumor combined with acute pancreatic inflammation; (4) Combined with coagulation dysfunction, after drug treatment , those who cannot improve; (5) patients with severe diabetes, after hypoglycemic therapy, the blood sugar is still higher than 17mmol/L; (6) patients with bacteremia and sepsis, can not accept radioactive seed implantation thera.
    Indications of percutaneous radiofrequency and microwave therapy for advanced pancreatic cancer: (1) after interventional therapy for advanced pancreatic cancer; (2) unresectable pancreatic cancer patients with an expected survival period of more than 3 months; (3) unwilling to accept (4) The expected survival time is less than 3 months, and the patient should be carefully selected to relieve persistent upper abdominal pain; (5) The tumor reduction therapy should be carefully selected for the primary pancreatic tumor with the largest diameter greater than 7 .
    Contraindications: (1) There is clear clinical evidence to prove that the pancreatic tumor has been widely metastasized; (2) Patients with cachexia; (3) Patients with acute pancreatitis; (4) Patients with coagulation dysfunction, which cannot be improved by drug treatment; (5) ) Combined with severe diabetes, hypoglycemic therapy, blood sugar can not be controlled below 16mmol/L; (6) Combined with bacteremia and seps.
    Indications for percutaneous intratumoral chemical-induced immunotherapy for advanced pancreatic cancer: (1) after interventional therapy for advanced pancreatic cancer; (2) unresectable pancreatic cancer patients with an estimated survival period of more than 3 months; (3) Patients who are reluctant to undergo pancreatic cancer resecti.
    Contraindications: (1) There is clear clinical evidence that the pancreatic tumor has been widely metastasized; (2) Patients with cachexia; (3) Patients with acute pancreatic inflammation; (4) Patients with coagulation disorders that cannot be improved by drug treatment; (5) Combined with severe diabetes, blood sugar can not be controlled below 16mmol/L by hypoglycemic treatment; (6) Combined with bacteremia and sepsis, radiofrequency and microwave therapy should not be accept.

    Optimal selection of interventional therapy for advanced pancreatic cancer Patients with advanced pancreatic cancer should treat the primary tumor and metastases as soon as possible, and simultaneously receive a comprehensive treatment of cTAI combined with physical thera.

    cTAI can effectively control the primary and metastatic lesions of pancreatic canc.

    The chemotherapy regimen should be determined according to the sensitivity of tumor cells to chemotherapeutic dru.

    Physical therapy includes particle, radiofrequency and microwave therapy for primary and metastatic lesio.

    Determination of tumor location, blood supply and internal structure (Table 2) TableSummary of interventional methods for advanced pancreatic cancer For patients with unresectable advanced pancreatic cancer, interventional treatments such as cTAI, 125I seed implantation, radiofrequency and microwave ablation are improvi.

    There is a relatively complete overall solution for patient survival treatment and surviv.

    According to tumor size, shape, location, anatomical relationship of adjacent organs, e.

    , choosing one or more interventional treatment methods can effectively improve the overall survival and quality of life of patients with advanced pancreatic canc.
    With the continuous development of genetic technology, molecular imaging technology, immunotherapy and other technologies, the curative effect of advanced pancreatic cancer will be further improv.

    The sixth editio.

    China Cancer Research Foundation Interventional Medicine Committee National Radiation and Therapy Clinical Medicine Research Cent.

    National Interventional Medicine Innovation Alliance (in preparatio.

    DOI: 113437.

    cn.

    j.

    2020040
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