Technique and status of EUS-guided fine-needle injection

摘要

LEARNING OBJECTIVES1. Be familiar with published trials that used EUS-guided fine-needle injection (EUS-FNI) techniques to deliver antitumor agents.2. Appreciate potential new agents for EUS-FNI.3. Be acquainted with the technique for EUS-FNI. Current treatment options for locally advanced pancreatic cancer include supportive care, chemotherapy (single or combination), and chemotherapy plus radiation therapy. Studies of gemcitabine combined with other cytotoxic agents have not shown a survival advantage over gemcitabine alone. A study of gemcitabine combined with the epidermal growth factor receptor antagonist, erlotinib, revealed a statistically significant, albeit modest, survival advantage in patients with advanced pancreatic cancer. Currently, studies of gemcitabine combined with other targeted therapies (eg, cetuximab and panitumumab) are in progress.For patients with "borderline" resectable pancreatic cancer, the best strategy seems to be aggressive downstaging of the tumor with local treatment, including radiation therapy, and systemic agents. Varadhachary et al concluded that, in their experience, patients with tumors that respond to neo-adjuvant therapy have a better chance of RO resection, which usually translates to increased survival.