%0 Journal Article
%T Endoscopic Ultrasound-Guided Oncologic Therapy for Pancreatic Cancer
%A Rei Suzuki
%A Atsushi Irisawa
%A Manoop S. Bhutani
%J Diagnostic and Therapeutic Endoscopy
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/157581
%X Since the development of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the early 1990s, its application has been extended to various diseases. For pancreatic cancer, EUS-FNA can obtain specimens from the tumor itself with fewer complications than other methods. Interventional EUS enables various therapeutic options: local ablation, brachytherapy, placement of fiducial markers for radiotherapy, and direct injection of antitumor agents into cancer. This paper will focus on EUS-guided oncologic therapy for pancreatic cancer. 1. Introduction Since endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was first utilized in clinical practice in the early 1990s, it has become a widely acceptable diagnostic procedure in gastrointestinal and pancreaticobiliary lesions [1]. Recently, its applications have been extended to therapeutic purposes for various diseases, including pancreatic cancer [2¨C4]. Pancreatic ductal adenocarcinoma is one of the most difficult tumors to treat, and patients with this disease have a poor prognosis. Only 15 to 20% of patients have resectable disease at diagnosis; approximately 40% have metastatic disease, and another 30 to 40% have locally advanced unresectable tumors. Despite the tremendous efforts of researchers and clinicians, the 5-year survival of patients with unresectable pancreatic cancer is still <5% [5]. To improve this dismal prognosis, endoscopic therapy (local therapy alone or in combination with systemic therapy) is considered as one option for such advanced cancers. The conventional approach is percutaneous image-guided delivery, for example, computed tomography (CT) guided, but this technique is cumbersome. EUS may be a suitable procedure for approaching the cancer itself via the gastrointestinal tract under real-time color Doppler, thus avoiding blood vessels or other organs. In this paper, we consider a variety of EUS-guided oncologic therapies for pancreatic cancer. 2. EUS-Guided Ablation Even though pancreatic cancer is considered to be a systemic disease, local ablation therapy has the potential to reduce tumor volume, thereby improving patientsĄŻ symptoms and prognosis. 2.1. Photodynamic Therapy Photodynamic therapy (PDT) provides localized tissue ablation through the use of an appropriate photosensitizer and light exposure. Photosensitizers (e.g., meso-tetra(hydroxyphenyl)chlorin, porfimer sodium, and verteporfin), which have unique characteristics and accumulate more in tumors than in normal tissue, are usually injected intravenously before the procedure. Light is generated with small
%U http://www.hindawi.com/journals/dte/2013/157581/