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Locoregional therapies and their effects on the tumoral microenvironment of pancreatic ductal adenocarcinoma

World Journal of Gastroenterology 2022年第13期28卷 1288-1303页

作者： Thomas Lambin Cyril Lafon Robert Andrew Drainville Mathieu Pioche Frédéric Prat LabTAU INSERMCentre Léon BérardUniversitéLyon 1Univ LyonLyon 69003France Department of Gastroenterology Hospices Civils de LyonEdouard Herriot HospitalLyon 69008France Service d’Endoscopie Digestive Hôpital BeaujonAssistance Publique-Hôpitaux de ParisClichy 92110France INSERM U1016 Institut CochinUniversitéde ParisParis 75014France

Pancreatic ductal adenocarcinoma(PDAC) is expected to become the second leading cause of death from cancer by 2030. Despite intensive research in the field of therapeutics, the 5-year overall survival is approximately 8%, with only 20% of patients eligible for surgery at the time of diagnosis. The tumoral microenvironment(TME) of the PDAC is one of the main causes for resistance to antitumoral treatments due to the presence of tumor vasculature, stroma, and a modified immune response. The TME of PDAC is characterized by high stiffness due to fibrosis, with hypo microvascular perfusion, along with an immunosuppressive environment that constitutes a barrier to effective antitumoral treatment. While systemic therapies often produce severe side effects that can alter patients’ quality of life, locoregional therapies have gained attention since their action is localized to the pancreas and can thus alleviate some of the barriers to effective antitumoral treatment due to their physical effects. Local hyperthermia using radiofrequency ablation and radiation therapy-most commonly using a local high single dose-are the two main modalities holding promise for clinical efficacy. Recently, irreversible electroporation and focused ultrasound-derived cavitation have gained increasing attention. To date, most of the data are limited to preclinical studies, but ongoing clinical trials may help better define the role of these locoregional therapies in the management of PDAC patients.

关键词： Pancreatic ductal adenocarcinoma tumoral microenvironment Stroma Hyperthermia Radiation therapy High-intensity focused ultrasound

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