국소 진행성 췌장암에서의 내시경적 국소 치료

Abstract

Pancreatic adenocarcinoma is one of the cancers with the poorest prognosis, and its incidence has gradually increased to become the 9th most common cancer in Korea in 2016. Surgical resection is the only treatment option to improve the cure and longterm survival rate. Unfortunately, only 10% to 20% of all pancreatic cancer patients present with resectable disease, because of common symptoms are rarely noticeable in its early stages and disease progress very quickly. Unresectable pancreatic cancer can be divided into locally advanced pancreatic cancer (LAPC) and metastatic disease. Pancreatic cancer with distant metastasis accounts for about 40–60% of the total pancreatic cancer and systemic chemotherapy is considered as standard treatment. LAPC is observed in 30–40%, defined as the tumor surrounding major blood vessels (especially, celiac artery and superior mesenteric artery) more than 180° without distant metastasis which cannot be completely removed by surgery. Standard treatment for LAPC has not yet been established, and chemotherapy and radiotherapy have mainly been used, but in most cases, response to these therapeutic options has been limited. As imaging techniques, endoscopic devices and procedures have recently been developed and the role of local endoscopic therapies for LAPC has expanded. This article provides an overview of local endoscopic treatment for LAPC such as injection therapy, radiofrequency ablation (RFA), irreversible electroporation (IRE), radiotherapy and drug-delivery stent insertion.