Current role of endoscopic ablation in the management of pancreatic cancer

Pancreatic cancer remains one of the most challenging malignancies to treat, with its incidence steadily rising owing to factors such as aging populations, lifestyle changes, and improved diagnostic capabilities. Surgery is an essential treatment; however, most patients are diagnosed at advanced stages. Conventional therapies offer limited survival benefits, underscoring the need for innovative approaches. Local treatments have emerged as critical strategies for improving tumor control and patient outcomes, particularly in unresectable or metastatic cases. Recent advancements include refinements in radiofrequency ablation (RFA), stereotactic body radiotherapy, irreversible electroporation, cryotherapy, and brachytherapy. RFA is a well-known modality that has been used effectively for the treatment of solid tumors such as hepatocellular cancer and cholangiocarcinoma. Cryotherapy offers targeted ablation with extreme cold, minimizing damage to surrounding tissues, whereas brachytherapy delivers localized radiation with precision, enhancing efficacy and reducing systemic toxicity. Nanoparticle-based drug delivery systems are an emerging trend in immunotherapy and advanced imaging techniques. This review evaluates advancements and declines in local treatments for unresectable pancreatic cancer. It underscores the importance of addressing rising pancreatic cancer rates through personalized approaches, robust clinical trials, and multidisciplinary collaboration to optimize therapeutic outcomes.