Present and Future of Local Therapies for Unresectable Pancreatic Cancer

Endoscopic ultrasound (EUS)-guided local therapy (LT) through delivery of antitumor agents has been recently proposed as an alternative treatment for pancreatic cancer (PC). It can be performed via a direct or indirect approach. The direct approach is based on the delivery of thermal or electrical energy leading to intralesional locoregional tissue damage. The indirect approach is based on the release of immunotherapeutic factors, chemotherapeutic agents, fiducial markers, and radioactive seeds with induction of a secondary antitumoral effect. This chapter reviews the different methods of the evolving EUS-LT technique for unresectable PC. The photosensitizer is able to transfer energy to oxygen molecules after excitation with laser light, releasing reactive oxygen species and singlet oxygen, with antitumor effects on both cancer cells and neovascular cells.