Pancreatic cancer is among the most aggressive malignancies, with a 5-year overall survival rate of approximately 10%. Despite the establishment of gemcitabine- and fluoropyrimidine-based combination chemotherapy as the standard of care, therapeutic outcomes remain poor due to inherent and acquired resistance to chemotherapy. In recent years, the development of targeted therapies has emerged as a promising treatment modality, driven by advances in molecular biology and genomic profiling. Notably, mutations in the KRAS gene—detected in nearly 90% of pancreatic cancer cases—are recognized as key oncogenic drivers, contributing significantly to tumor initiation, progression, and therapeutic resistance. As such, KRAS has become a focal point for therapeutic intervention. Strategies aimed at targeting KRAS include (1) direct inhibitors of specific KRAS mutations, (2) inhibitors of upstream regulators such as SOS1 and SHP2, and (3) inhibitors of downstream effectors within the RAS signaling cascade. Given the challenges posed by compensatory signaling mechanisms that reduce the efficacy of direct KRAS inhibitors, ongoing research is exploring alternative approaches such as pan-KRAS inhibitors, combination regimens that pair KRAS inhibitors with cytotoxic chemotherapy, and dualtarget strategies involving upstream and downstream signaling components. For the subset of patients (approximately 10%) with wild-type KRAS, the U.S. Food and Drug Administration has approved targeted therapies for tumors harboring specific rare genetic alterations, including NTRK, BRAF, NRG1, ALK, ROS1, RET, and those with mismatch repair deficiency or microsatellite instability-high status. Furthermore, poly(ADP-ribose) polymerase inhibitors have shown clinical benefit in patients with germline or somatic mutations in DNA damage repair genes such as BRCA1, BRCA2, and PALB2.

Pancreatic cancer is among the most aggressive malignancies, with a 5-year overall survival rate of approximately 10%. Despite the establishment of gemcitabine- and fluoropyrimidine-based combination chemotherapy as the standard of care, therapeutic outcomes remain poor due to inherent and acquired resistance to chemotherapy. In recent years, the development of targeted therapies has emerged as a promising treatment modality, driven by advances in molecular biology and genomic profiling. Notably, mutations in the KRAS gene—detected in nearly 90% of pancreatic cancer cases—are recognized as key oncogenic drivers, contributing significantly to tumor initiation, progression, and therapeutic resistance. As such, KRAS has become a focal point for therapeutic intervention. Strategies aimed at targeting KRAS include (1) direct inhibitors of specific KRAS mutations, (2) inhibitors of upstream regulators such as SOS1 and SHP2, and (3) inhibitors of downstream effectors within the RAS signaling cascade. Given the challenges posed by compensatory signaling mechanisms that reduce the efficacy of direct KRAS inhibitors, ongoing research is exploring alternative approaches such as pan-KRAS inhibitors, combination regimens that pair KRAS inhibitors with cytotoxic chemotherapy, and dualtarget strategies involving upstream and downstream signaling components. For the subset of patients (approximately 10%) with wild-type KRAS, the U.S. Food and Drug Administration has approved targeted therapies for tumors harboring specific rare genetic alterations, including NTRK, BRAF, NRG1, ALK, ROS1, RET, and those with mismatch repair deficiency or microsatellite instability-high status. Furthermore, poly(ADP-ribose) polymerase inhibitors have shown clinical benefit in patients with germline or somatic mutations in DNA damage repair genes such as BRCA1, BRCA2, and PALB2.

Pancreatic cancer is among the most aggressive malignancies, with a 5-year overall survival rate of approximately 10%. Despite the establishment of gemcitabine- and fluoropyrimidine-based combination chemotherapy as the standard of care, therapeutic outcomes remain poor due to inherent and acquired resistance to chemotherapy. In recent years, the development of targeted therapies has emerged as a promising treatment modality, driven by advances in molecular biology and genomic profiling. Notably, mutations in the KRAS gene—detected in nearly 90% of pancreatic cancer cases—are recognized as key oncogenic drivers, contributing significantly to tumor initiation, progression, and therapeutic resistance. As such, KRAS has become a focal point for therapeutic intervention. Strategies aimed at targeting KRAS include (1) direct inhibitors of specific KRAS mutations, (2) inhibitors of upstream regulators such as SOS1 and SHP2, and (3) inhibitors of downstream effectors within the RAS signaling cascade. Given the challenges posed by compensatory signaling mechanisms that reduce the efficacy of direct KRAS inhibitors, ongoing research is exploring alternative approaches such as pan-KRAS inhibitors, combination regimens that pair KRAS inhibitors with cytotoxic chemotherapy, and dualtarget strategies involving upstream and downstream signaling components. For the subset of patients (approximately 10%) with wild-type KRAS, the U.S. Food and Drug Administration has approved targeted therapies for tumors harboring specific rare genetic alterations, including NTRK, BRAF, NRG1, ALK, ROS1, RET, and those with mismatch repair deficiency or microsatellite instability-high status. Furthermore, poly(ADP-ribose) polymerase inhibitors have shown clinical benefit in patients with germline or somatic mutations in DNA damage repair genes such as BRCA1, BRCA2, and PALB2.

Pancreatic cancer has a very poor prognosis. Complete surgical resection remains the only current curative treatment. Locally advanced pancreatic cancer (LAPC) is considered as unresectable because of involvement of celiac and/or mesenteric vessels. The treatment of LAPC is a challenge. Current guidelines suggest systemic therapy. However, the majority of patients will never experience conversion to surgical resection. Thus, in these patients, ablation is an alternative therapy for local control, which causes local destruction while ideally avoiding injury to surrounding healthy tissue. Irreversible electroporation (IRE) is an energy delivery system, effective in ablating tumors by inducing irreversible membrane destruction of cells. IRE demonstrated to be safe in previous studies. However, it is not free from complications, even serious. Here, we reported two cases of the IRE in LAPC patients.
Electroporation ; Humans ; Membranes ; Pancreatic Neoplasms ; Prognosis

Complement component 3 glomerulonephritis (C3GN) is a rare kidney disease characterized by complement dysregulation that results in prominent complement component 3 (C3) deposition in the kidneys. The clinical course of C3GN varies from mild hematuria to progressive chronic kidney disease. In most patients, C3GN is driven by acquired factors, namely, autoantibodies that target C3 or C5 convertases. Genetic variations in complement-related genes are less frequent. We report the case of a 9-yearold Korean boy who presented with microscopic hematuria and a persistently low C3 level and had biopsy findings of C3GN, with the presence of a C3 gene mutation: a frameshift mutation associated with C3 deficiency. However, the patient did not exhibit any other symptoms of complement deficiency. Direct DNA sequencing of his family members revealed the same genetic mutation in his father and older brother. This case report is significant because there are very few such reports worldwide concerning gene mutations related to C3 deficiency to be discovered in patients with C3GN. Explaining C3GN pathogenesis is challenging; therefore, additional research is required in the future.

Background/Aims: Controversy regarding the effectiveness of neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma (PDAC) still exists. Here, we aimed to identify the potential benefits of neoadjuvant therapy followed by surgery for resectable PDAC. Methods: We reviewed radiologically resectable PDAC patients who received resection with curative intent at a tertiary hospital in South Korea between January 2012 and August 2019. A total of 202 patients underwent curative resection for resectable PDAC: 167 underwent surgical resection first during this period, and 35 received neoadjuvant chemotherapy/chemoradiation therapy followed by surgery. Resectable PDAC patients were subdivided, and 1:3 propensity score matching (PSM) was performed to reduce selection bias. Results: Compared with the group that received surgery first, the group that received neoadjuvant treatment followed by surgery had significantly smaller tumors (22.0 mm vs 27.0 mm, p=0.004), a smaller proportion of patients with postoperative pathologic T stage (p=0.026), a smaller proportion of patients with lymphovascular invasion (20.0% vs 40.7%, p=0.022), and a larger proportion of patients with negative resection margins (74.3% vs 51.5%, p=0.049). After PSM, the group that received neoadjuvant therapy had a significantly longer progression-free survival than those in the group that underwent surgery first (29.6 months vs 15.1 months, p=0.002). Overall survival was not significantly different between the two groups after PSM analysis. Conclusions We observed significantly better surgical outcomes and progression-free survival with the addition of neoadjuvant therapy to the management of resectable PDAC. However, despite PSM, there was still selection bias due to the use of different regimens between the groups receiving surgery first and neoadjuvant therapy. Large homogeneous samples are needed in the future prospective studies.

As fluoroscopy-guided interventional procedures gain popularity, the associated health threats from radiation exposure to interventionalists during these procedures are increasing. Therefore, an understanding of the potential risks of radiation and careful consideration on minimizing exposure to radiation during the procedures are of paramount importance. The Korean Pancreatobiliary Association has developed a clinical practice guideline to minimize radiation exposure during fluoroscopy-guided interventional procedures. This guideline provides recommendations to deal with the risk of radiation exposure to interventionalists who perform fluoroscopy-guided procedures, and emphasizes the importance of proper and practical approaches to avoid unnecessary radiation exposure.

As fluoroscopy-guided interventional procedures gain popularity, the associated health threats from radiation exposure to interventionalists during these procedures are increasing. Therefore, an understanding of the potential risks of radiation and careful consideration on minimizing exposure to radiation during the procedures are of paramount importance. The Korean Pancreatobiliary Association has developed a clinical practice guideline to minimize radiation exposure during fluoroscopy-guided interventional procedures. This guideline provides recommendations to deal with the risk of radiation exposure to interventionalists who perform fluoroscopy-guided procedures, and emphasizes the importance of proper and practical approaches to avoid unnecessary radiation exposure.

As fluoroscopy-guided interventional procedures gain popularity, the associated health threats from radiation exposure to interventionalists during these procedures are increasing. Therefore, an understanding of the potential risks of radiation and careful consideration on minimizing exposure to radiation during the procedures are of paramount importance. The Korean Pancreatobiliary Association has developed a clinical practice guideline to minimize radiation exposure during fluoroscopy-guided interventional procedures. This guideline provides recommendations to deal with the risk of radiation exposure to interventionalists who perform fluoroscopy-guided procedures, and emphasizes the importance of proper and practical approaches to avoid unnecessary radiation exposure.

As fluoroscopy-guided interventional procedures gain popularity, the associated health threats from radiation exposure to interventionalists during these procedures are increasing. Therefore, an understanding of the potential risks of radiation and careful consideration on minimizing exposure to radiation during the procedures are of paramount importance. The Korean Pancreatobiliary Association has developed a clinical practice guideline to minimize radiation exposure during fluoroscopy-guided interventional procedures. This guideline provides recommendations to deal with the risk of radiation exposure to interventionalists who perform fluoroscopy-guided procedures, and emphasizes the importance of proper and practical approaches to avoid unnecessary radiation exposure.