基于多学科诊疗模式的高强度聚焦超声联合化疗在中晚期胰腺癌新辅助及转化治疗中的应用：附4例报告

Application of High-intensity focused ultrasound combined with chemotherapy as neoadjuvant and conversion therapy for advanced pancreatic cancer based on a multidisciplinary treatment model: a report of 4 cases

摘要:

胰腺癌以侵袭性强、早期隐匿及预后差著称，大多数患者确诊时已属中晚期，失去根治性手术机会。本研究回顾性分析中南大学湘雅三医院4例局部中晚期胰腺癌患者的诊治过程，探讨高强度聚焦超声（HIFU）消融联合化疗作为新辅助及转化治疗策略的临床价值与安全性。所有病例均经多学科诊疗团队综合评估后制定个体化方案，并接受HIFU联合吉西他滨+白蛋白紫杉醇方案治疗，系统评估肿瘤体积、血管受累、手术转化情况及症状改善，并记录不良事件。结果显示，3例患者经治疗后肿瘤显著缩小，血管侵犯明显减轻，均成功实施R₀切除，术后随访未见复发；另1例患者虽未达到手术条件，但病情稳定、疼痛显著缓解，长期带瘤生存且生活质量良好。所有患者均耐受治疗，未出现严重不良反应。研究表明，HIFU联合化疗在促进肿瘤降期、提高手术转化率及缓解症状方面具有明显优势，其局部热消融与全身化疗的协同效应有助于克服胰腺癌局部控制难及药物渗透不足的局限。作为一种安全、微创且可重复实施的综合治疗手段，该策略为中晚期胰腺癌患者提供了新的治疗思路和可行方案，但仍需大样本、前瞻性研究进一步验证其长期疗效与机制。

Abstract:

Pancreatic cancer is highly aggressive and often diagnosed at an advanced stage, leaving most patients ineligible for radical resection. This study retrospectively analyzed four patients with locally advanced or advanced pancreatic cancer to evaluate the clinical efficacy and safety of high-intensity focused ultrasound (HIFU) ablation combined with chemotherapy as a neoadjuvant and conversion therapy. All cases were reviewed and individualized treatment plans were formulated through a multidisciplinary team evaluation. All patients received HIFU plus gemcitabine and nab-paclitaxel chemotherapy, with assessments of tumor volume, vascular involvement, surgical conversion, symptom relief, and adverse events. Three patients achieved marked tumor shrinkage and reduction of vascular invasion, enabling successful R₀ resection without recurrence during follow-up. The remaining patient achieved disease stability, significant pain relief, and maintained good quality of life under repeated HIFU therapy. All treatments were well tolerated, and no severe adverse reactions occurred. The combination of HIFU and chemotherapy demonstrated synergistic local and systemic effects, effectively achieving tumor downstaging, improving resectability, and alleviating symptoms. As a safe, noninvasive, and repeatable therapeutic approach, this strategy offers a promising option for patients with advanced pancreatic cancer. Further large-scale prospective studies are warranted to validate its long-term efficacy and elucidate underlying mechanisms.