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.