Our new treatments for stage 4 pancreatic cancer
In stage 4 pancreatic cancer, the tumor in the pancreas has spread to organs such as the liver, lung and peritoneum. The only treatment recommended at this stage is chemotherapy, but survival with classical chemotherapy is quite short.

Is percutaneous ablation useful in stage 4 pancreatic cancer?
In some stage 4 pancreatic cancer patients, ablation therapy can be very helpful. For example, if pancreatic cancer has spread only to the liver or lung and the number of metastases is not very high, we can apply cryoablation to the tumor in the pancreas, and cryoablation or microwave ablation to the tumors in the liver and lung, depending on their location and size. At our centers, we generally complete these treatments in 1-2 sessions in several days. In this way, it is possible to eliminate at least 80-90% of the tumor burden in the patient's body.  After ablation procedures, we usually perform intratumoral immunotherapy to increase tumor-specific immunity in the patient, by injecting low doses of drugs called immune checkpoint inhibitors into the tumors we ablate. 






















Can percutaneous ablation be performed while the patient is receiving chemotherapy? Percutaneous ablation treatments can be applied not only in pancreatic cancer but also in all cancer types while the patient is receiving chemotherapy. The only conditions are, the patient's blood values, especially platelet counts, should not be too low as a result of the chemotherapy and the patient's general condition should not be poor. If blood values ​​are low, they ​​should be normalized first by giving blood products to the patient before the ablation is performed.

However, in a patient newly diagnosed with stage 4 pancreatic cancer, if chemotherapy has not yet been started, we prefer to perform percutaneous ablation treatment before the chemotherapy. There are 2 reasons for this:

1. In some patients, blood values ​​may drop permanently due to chemotherapy or the patient's general condition may worsen, such that it may not be possible to apply ablation treatment. In this case, the patient may lose the chance of ablation. If percutaneous ablation is performed first, since it is well-tolerated by the patients, there will be no obstacle to chemotherapy.

2. In stage 4 patients, normally ultrasound shows liver metastases very clearly. However, if the patient is receiving chemotherapy, the liver metastases will become poorly visible on ultrasound and thus, percutaneous ablation may become technically difficult.

Therefore, in stage 4 patients who have not started chemotherapy, if percutaneous ablation treatment is planned, we recommend that the patient first undergo ablation and then continue chemotherapy.
​





















What are the benefits of ablation treatments in stage 4 pancreatic cancer?
1. Percutaneous ablation is generally well-tolerated by the patients and does not require hospitalization. At our centers, it is performed through a needle puncture under local anesthesia and the procedure only takes 1-2 hours. The patient can be discharged on the same day. AS a result percutaneous ablation will not complicate other treatments, such as chemotherapy or immunotherapy.

2. In a single session of ablation, it is generally possible to eliminate at least 80-90% of the tumor burden in the body.

3. Cryoablation is one of the most effective methods for relieving pain due to pancreatic cancer. After cryoablation, the patient's pain decreases, making it easier for the patient to receive other treatments such as chemotherapy.

4. After ablation, intratumoral immunotherapy can be performed in appropriate patients. Immunotherapy and ablation treatments enhance each other's effects (synergy) and both local and systemic immunity can be increased with post-ablation intratumoral immunotherapy. 

5. Unlike radiotherapy, ablation treatments are repeatable. If the cancer recurs, cryoablation can be repeated as many times as necessary in the same area.