Locoregional and Injectable Interventional Therapies for Locally Advanced Pancreatic Cancer: A Narrative Review with Perspectives on Oligometastatic Disease
Danielle J. W. Vos, Laura Olivieri, Florentine E. F. Timmer, Madelon Dijkstra, Susan van der Lei, Hannah Schulz, Roel Bennink, Marc G. Besselink, Anna M. E. Bruynzeel, Tanja de Gruijl, Johanna W. Wilmink, Rosario F. Grasso, Martijn R. MeijerinkAbstract
Locally advanced pancreatic cancer (LAPC) and oligometastatic pancreatic cancer (OMPC) remain associated with poor prognosis despite advances in systemic therapy. In carefully selected patients demonstrating disease stability or response to chemotherapy, image-guided locoregional interventions are increasingly explored as adjunctive strategies to enhance local tumor control, facilitate downstaging, and potentially contribute to systemic disease modulation. A wide spectrum of interventional approaches has emerged, including needle-guided ablative energy modalities, intratumoral injection therapies, noninvasive external energy delivery techniques, and transarterial or catheter-based platforms. These techniques rely on diverse mechanisms of action, ranging from thermal and nonthermal cytotoxicity to radiation delivery, mechanical disruption, and immune activation, reflecting the expanding role of interventional radiology in oncologic care. Among available strategies, stereotactic radiotherapy and electroporation-based techniques currently show the most advanced clinical integration, although definitive survival benefits remain uncertain. In parallel, novel intratumoral and catheter-directed therapies are rapidly evolving, with growing interest in approaches capable of inducing immunogenic cell death and enhancing response to systemic treatments. This narrative review provides an interventional radiology–focused synthesis of emerging locoregional and injectable therapies in LAPC and OMPC, emphasizing technical considerations, mechanisms of action, and clinical evidence. Particular attention is given to the integration of these modalities within multimodality treatment pathways and to future directions aimed at optimizing patient selection, standardizing procedural strategies, and leveraging immunomodulatory effects to improve outcomes in this highly aggressive disease.