Cryoablation in locally advanced pancreatic cancer: A promising ablative frontier

Abstract

Locally advanced pancreatic cancer represents a challenging intersection between potentially resectable and metastatic disease. Despite modern systemic therapies such as modified FOLFIRINOX or gemcitabine plus nab-paclitaxel, survival outcomes remain limited, and local progression continues to be a major driver of morbidity. Ablative techniques – including irreversible electroporation, cryoablation, radiofrequency ablation, microwave ablation, stereotactic body radiotherapy, and intratumoral injection therapies – have emerged as promising modalities to improve local control and potentially stimulate systemic immune responses. Among these modalities, cryoablation stands out due to its unique ability to induce immunogenic cell death while preserving antigenic structures. This minireview synthesizes the current evidence across all ablative strategies, highlighting their mechanisms, clinical outcomes, and immunomodulatory effects, and discusses future integration into multimodal locally advanced pancreatic cancer treatment paradigms.

Keywords: Locally advanced pancreatic cancer; Cryoablation; Irreversible electroporation; Radiofrequency ablation; Microwave ablation; Stereotactic body radiotherapy; Intratumoral injection; Immunotherapy; Multimodal therapy; Immunomodulation

Core Tip: Ablative therapies are transforming the therapeutic landscape of locally advanced pancreatic cancer. Among these, cryoablation stands out for its unique dual mechanism – precise cytoreduction and potent immune activation. Incorporation of ablative modalities into multimodal protocols promises improved local control and novel systemic synergy.