HIFU无创治疗中晚期胰腺癌的临床应用进展
Clinical Application Progress of HIFU Non-Invasive Therapy for Advanced Pancreatic Cancer
DOI: 10.12677/acm.2025.15123461, PDF,    科研立项经费支持
作者: 陈金翠, 计晓娟*：重庆医科大学，重庆；重庆市人民医院超声科，重庆
关键词: 胰腺癌；高强度聚焦超声；无创治疗；联合治疗；预后；Pancreatic Cancer； High-Intensity Focused Ultrasound； Combination Therapy； Clinical Efficacy； Multidisciplinary Treatment
摘要: 胰腺癌起病隐匿，是消化系统预后极差的恶性肿瘤，被称为癌中之王，严重危害人民健康。胰腺癌5年生存率仅为4.3%，中位生存时间为12.4 ± 6.6个月{Bahardoust, #13}，而肿瘤乏血供特性常常大大降低化疗效果。近年来，高强度聚焦超声(high-intensity focused ultrasound, HIFU)已广泛用于无创治疗肝脏、骨骼、子宫、乳腺等器官肿瘤，获得临床高度认可。本文系统综述HIFU的治疗机制、联合治疗策略(化疗、放疗、中医药)及临床疗效评估(局部肿瘤控制、生存期延长、疼痛缓解)在胰腺癌综合治疗中的应用进展。
Abstract: Pancreatic cancer is an insidious malignancy of the digestive system, recognized as the “king of cancers” due to its extremely poor prognosis and substantial threat to public health. The 5-year survival rate is only 4.3%, with a median survival time of 12.4 ± 6.6 month. The hypovascular nature of pancreatic tumors often limits the efficacy of conventional chemotherapy. In recent years, high-intensity focused ultrasound (HIFU) has been widely applied as a non-invasive therapeutic modality for liver, bone, uterine, and breast tumors, and has gained substantial clinical acceptance. This paper provides a systematic review of the current advances in HIFU for the comprehensive management of pancreatic cancer, including its therapeutic mechanisms, combination strategies with chemotherapy, radiotherapy, and traditional Chinese medicine, and clinical outcome assessments such as local tumor control, prolongation of survival, and pain relief. The findings aim to inform multidisciplinary treatment approaches for pancreatic cancer.
文章引用：陈金翠, 计晓娟. HIFU无创治疗中晚期胰腺癌的临床应用进展[J]. 临床医学进展, 2025, 15(12): 703-710. https://doi.org/10.12677/acm.2025.15123461

参考文献

[1] Bahardoust, M., Abyazi, M.A., Emami, S.A., Ghadimi, P., Khodabandeh, M., Mahmoudi, F., et al. (2021) Predictors of Survival Rate in Patients with Pancreatic Cancer: A Multi‐Center Analytical Study in Iran. Cancer Reports, 5, e1547. [Google Scholar] [CrossRef] [PubMed]
[2] Karunakaran, M. and Barreto, S.G. (2021) Surgery for Pancreatic Cancer: Current Controversies and Challenges. Future Oncology, 17, 5135-5162. [Google Scholar] [CrossRef] [PubMed]
[3] Lambert, A., Schwarz, L., Ducreux, M. and Conroy, T. (2021) Neoadjuvant Treatment Strategies in Resectable Pancreatic Cancer. Cancers, 13, Article No. 4724. [Google Scholar] [CrossRef] [PubMed]
[4] 王德忱. 高强度超声聚焦缓解胰腺癌疼痛的临床效果观察[J]. 中国医疗器械信息, 2023, 29(7): 98-100.
[5] 蔡湘怡, 干峰. 高强度聚焦超声在晚期胰腺癌治疗中的应用进展[J]. 医疗卫生装备, 2020, 41(7): 99-103.
[6] Gray, M.D., Lyon, P.C., Mannaris, C., Folkes, L.K., Stratford, M., Campo, L., et al. (2019) Focused Ultrasound Hyperthermia for Targeted Drug Release from Thermosensitive Liposomes: Results from a Phase I Trial. Radiology, 291, 232-238. [Google Scholar] [CrossRef] [PubMed]
[7] Khokhlova, T.D. and Hwang, J.H. (2011) HIFU for Palliative Treatment of Pancreatic Cancer. Journal of Gastrointestinal Oncology, 2, 175-184.
[8] Cirincione, R., Di Maggio, F.M., Forte, G.I., Minafra, L., Bravatà, V., Castiglia, L., et al. (2017) High-Intensity Focused Ultrasound-and Radiation Therapy-Induced Immuno-Modulation: Comparison and Potential Opportunities. Ultrasound in Medicine & Biology, 43, 398-411. [Google Scholar] [CrossRef] [PubMed]
[9] Marinova, M., Huxold, H.C., Henseler, J., Mücke, M., Conrad, R., Rolke, R., et al. (2018) Clinical Effectiveness and Potential Survival Benefit of Us-Guided High-Intensity Focused Ultrasound Therapy in Patients with Advanced-Stage Pancreatic Cancer. Ultraschall in der Medizin-European Journal of Ultrasound, 40, 625-637. [Google Scholar] [CrossRef] [PubMed]
[10] 余怡, 许青, 朱忠政, 等. 胰腺癌高强度聚焦超声治疗对全身炎症反应的影响[J]. 现代肿瘤医学, 2018, 26(12): 1884-1887.
[11] 石乔, 刘垒, 张晓艺, 等. 国内应用吉西他滨联合高强度聚焦超声治疗中晚期胰腺癌疗效的Meta分析[J]. 临床外科杂志, 2019, 27(8): 680-683.
[12] 张旺利, 刘永永, 王兴军, 等. 高强度聚焦超声对晚期胰腺癌疗效及肿瘤标志物的影响[J]. 中国肿瘤外科杂志, 2018, 10(3): 178-181.
[13] Dong, S., Zhong, A., Zhu, H., Wang, K., Cheng, C. and Meng, Z. (2023) Sequential High-Intensity Focused Ultrasound Treatment Combined with Chemotherapy for Inoperable Pancreatic Cancer: A Retrospective Analysis for Prognostic Factors and Survival Outcomes. International Journal of Hyperthermia, 40, Article ID: 2278417. [Google Scholar] [CrossRef] [PubMed]
[14] 施琦, 马士杰, 周传文, 等. 放疗联合高强度聚焦超声治疗胰腺癌的研究[J]. 中国现代医学杂志, 2020, 30(7): 59-63.
[15] 李婧. 高强度聚焦超声联合放疗对晚期胰腺癌患者肿瘤恶性程度的影响及毒副作用评价[J]. 海南医学院学报, 2017, 23(2): 217-220.
[16] Guo, J., Wang, Y., Chen, J., Qiu, W. and Chen, W. (2021) Systematic Review and Trial Sequential Analysis of High-Intensity Focused Ultrasound Combined with Chemotherapy versus Chemotherapy in the Treatment of Unresectable Pancreatic Ductal Adenocarcinoma. International Journal of Hyperthermia, 38, 1375-1383. [Google Scholar] [CrossRef] [PubMed]
[17] 张爱红. 调脾抑胰方联合高强度聚焦超声治疗局部晚期胰腺癌疗效观察[J]. 现代中西医结合杂志, 2020, 29(9): 995-997+1007.
[18] 李娜, 张青, 刘声, 等. 调肝理脾化积方联合高强度聚焦超声治疗局部晚期胰腺癌临床研究[J]. 中国中医药信息杂志, 2017, 24(7): 23-27.
[19] Mouratidis, P.X.E. and ter Haar, G. (2022) Latest Advances in the Use of Therapeutic Focused Ultrasound in the Treatment of Pancreatic Cancer. Cancers, 14, Article No. 638. [Google Scholar] [CrossRef] [PubMed]
[20] van den Tempel, N., Horsman, M.R. and Kanaar, R. (2016) Improving Efficacy of Hyperthermia in Oncology by Exploiting Biological Mechanisms. International Journal of Hyperthermia, 32, 446-454. [Google Scholar] [CrossRef] [PubMed]
[21] Mouratidis, P.X.E. and ter Haar, G. (2021) HSP90 Inhibition Acts Synergistically with Heat to Induce a Pro-Immunogenic Form of Cell Death in Colon Cancer Cells. International Journal of Hyperthermia, 38, 1443-1456. [Google Scholar] [CrossRef] [PubMed]
[22] Fergadi, M.P., Magouliotis, D.E., Rountas, C., Vlychou, M., Athanasiou, T., Symeonidis, D., et al. (2021) A Meta-Analysis Evaluating the Role of High-Intensity Focused Ultrasound (HIFU) as a Fourth Treatment Modality for Patients with Locally Advanced Pancreatic Cancer. Abdominal Radiology, 47, 254-264. [Google Scholar] [CrossRef] [PubMed]
[23] Marinova, M., Strunk, H.M., Rauch, M., Henseler, J., Clarens, T., Brüx, L., et al. (2016) High-Intensity Focused Ultrasound (HIFU) for Tumor Pain Relief in Inoperable Pancreatic Cancer: Evaluation with the Pain Sensation Scale (SES). Schmerz, 31, 31-39. [Google Scholar] [CrossRef] [PubMed]
[24] Dababou, S., Marrocchio, C., Rosenberg, J., Bitton, R., Pauly, K.B., Napoli, A., et al. (2017) A Meta-Analysis of Palliative Treatment of Pancreatic Cancer with High Intensity Focused Ultrasound. Journal of Therapeutic Ultrasound, 5, Article No. 9. [Google Scholar] [CrossRef] [PubMed]
[25] Tonguc, T., Strunk, H., Gonzalez-Carmona, M.A., Recker, F., Lütjohann, D., Thudium, M., et al. (2021) US-Guided High-Intensity Focused Ultrasound (HIFU) of Abdominal Tumors: Outcome, Early Ablation-Related Laboratory Changes and Inflammatory Reaction. a Single-Center Experience from Germany. International Journal of Hyperthermia, 38, 65-74. [Google Scholar] [CrossRef] [PubMed]
[26] Jiang, F., He, M., Liu, Y.J., Wang, Z.B., Zhang, L. and Bai, J. (2013) High Intensity Focused Ultrasound Ablation of Goat Liver in Vivo: Pathologic Changes of Portal Vein and the “Heat-Sink” Effect. Ultrasonics, 53, 77-83. [Google Scholar] [CrossRef] [PubMed]
[27] 王时峰, 赵鑫, 郭月皓. 高强度聚焦超声治疗系统治疗胰腺癌临床应用[J]. 山西大同大学学报(自然科学版), 2020, 36(6): 68-71.
[28] Yang, W., Zhu, B., Li, J., Diao, L., Ma, K. and Fan, Y. (2019) High-Intensity Focused Ultrasound Ablation for Advanced Pancreatic Cancer. Journal of Cancer Research and Therapeutics, 15, 831-835. [Google Scholar] [CrossRef] [PubMed]
[29] 门建涛, 丁新敏, 叶剑飞, 等. 高强度聚焦超声治疗对缓解胰腺癌疼痛的疗效观察[J]. 中国医疗器械信息, 2020, 26(6): 137-138.
[30] 祝宝让, 李静, 刁立岩, 等. 进展期胰腺癌的高强度聚焦超声消融治疗[C]//中国超声医学工程学会. 中国超声医学工程学会成立四十周年暨第十四次全国超声医学学术大会论文汇编(下册). 北京: 科学技术文献出版社, 2024: 428.
[31] De Grandis, M.C., Ascenti, V., Lanza, C., Di Paolo, G., Galassi, B., Ierardi, A.M., et al. (2023) Locoregional Therapies and Remodeling of Tumor Microenvironment in Pancreatic Cancer. International Journal of Molecular Sciences, 24, Article No. 12681. [Google Scholar] [CrossRef] [PubMed]
[32] Baek, B., Park, H., Choi, J., Lee, E. and Seong, S. (2025) HIFU-CCL19/21 Axis Enhances Dendritic Cell Vaccine Efficacy in the Tumor Microenvironment. Pharmaceutics, 17, Article No. 65. [Google Scholar] [CrossRef] [PubMed]
[33] Kuai, X., Zhu, Y., Yuan, Z., Wang, S., Lin, L., Ye, X., et al. (2022) Perfluorooctyl Bromide Nanoemulsions Holding MnO(2) Nanoparticles with Dual-Modality Imaging and Glutathione Depletion Enhanced HIFU-Eliciting Tumor Immunogenic Cell Death. Acta Pharmaceutica Sinica B, 12, 967-981. [Google Scholar] [CrossRef] [PubMed]

为你推荐