(O P6) Focused Ultrasound and Concurrent Chemotherapy for Locally Advanced Pancreatic Cancer: A Systematic Review

Introduction: Locally advanced pancreatic cancer (LAPC) responds poorly to systemic therapy, with 15-20% conversion to resectability, and median survival of approximately 15 months. Focused ultrasound (FUS) is a non-invasive therapy with ablative properties and the potential to augment drug delivery. Our objective was to systematically review the literature regarding the combination of FUS and chemotherapy in LAPC.

Methods: MEDLINE, Embase, and Cochrane databases were searched. Inclusion criteria were any series or trial of patients with LAPC undergoing FUS treatment concurrently with chemotherapy. Studies including both LAPC and metastatic cancer were included. Case studies and non-English papers were excluded. Outcomes included FUS-specific adverse events, conversion to resectability, overall survival (OS), and objective response rate.

Results: Initial search yielded 143 citations, with 9 included after full review. This included two randomized trials and seven retrospective cohorts comprising 579 patients treated with FUS and chemotherapy, primarily gemcitabine. Clinical heterogeneity was high with various clinical stages, chemotherapy regimens, and FUS settings. Included patients were 65% stage 4 and 29% stage 3. Five studies used one session of ablative FUS, while four used multiple (10-14) sessions. In four papers reporting resectability, 23.4% of stage 3 patients were able to undergo resection. Median OS ranged from 7.4 – 19.5 months. Every paper that reported a control group (n=4) showed a statistically significant increase in OS. Severe FUS-specific adverse events were reported in 3 patients (0.5%).

Conclusions: The combination of FUS and chemotherapy for LAPC shows promising results with minimal toxicity. It requires prospective study with protocols including standard of care chemotherapy.