Endoscopic ultrasound delivery of an antitumor agent to treat a case of pancreatic cancer.

BACKGROUND: A 72-year-old white male presented to a University Digestive Disease Center with epigastric pain and weight loss. A CT scan suggested that the patient had a mass in his pancreas and he was referred for further diagnostic work-up, staging and treatment. INVESTIGATIONS: Endoscopic ultrasound (EUS), EUS-guided fine-needle aspiration. DIAGNOSIS: Locally advanced, unresectable adenocarcinoma of the pancreas. MANAGEMENT: Opioid analgesics and EUS-guided celiac neurolysis (transgastric injection of bupivacaine and alcohol on both sides of the celiac artery) for pain relief. Five once-weekly intratumoral injections of TNFerade (GenVec, Inc., Gaithersburg, MD) by EUS-guided fine needle injection, in combination with chemoradiation (5 FU/XRT), as part of a multicenter clinical trial. Repeat fine-needle aspiration followed by surgical resection of the tumor.