The Role and Clinical Outcomes of EUS-Guided Radiofrequency Ablation in Pancreatic Tumors

Aims Advances in imaging techniques have increased the detection of incidental pancreatic lesions. Additionally, pancreatic cancers are often detected at locally advanced or metastatic stages. While primary curative treatment for pancreatic tumors is surgery, chemotherapy/radiotherapy are the primary treatment options for locally advanced/metastatic tumors. Radiofrequency ablation(RFA) is also being used as an effective method for hepatocellular carcinoma, liver metastases, and unresectable pancreatic tumors. EUS-RFA provides effective ablation with a low side effect profile through real-time imaging. This study aims to investigate the effects of EUS-RFA on clinical outcomes and follow-up parameters in patients.

Methods Data from 15 patients who underwent EUS-RFA between 2019 and 2024 for locally advanced/metastatic pancreatic tumors and neuroendocrine tumors (NETs) were retrospectively reviewed. Endosonographic examinations were performed using a linear echoendoscope (EG-3870UTK and EG38-J10UT Linear-Array Ultrasound Gastroscope, Pentax Europe GmbH,Germany). For RFA, the EUSRA™(EUS-Guided RFA, Taewoong Medical, South Korea) was used.

Results The median age of the patients was 65 years (range, 25-89 years), and 6 (40%) were female. Tumors were mostly located at the pancreatic head (5 patients). The median diameter of the RFA-applied lesions was 35 mm (15-60 mm); biopsy results showed adenocarcinoma in 13 lesions, metastatic NET in one, and functional NET (insulinoma) in one patient. Seven tumors were metastatic, and the other seven were locally-advanced stage. RFA was administered in 1 to 3 sessions, with 30-50 watts and durations of 10-30 seconds. At the 9-month follow-up, 66% of patients were still alive, with the median tumor diameter reduced from 35 mm to 28 mm. All surviving patients had preserved total hypodense necrotic area. In the patient applied RFA for insulinoma, hypoglycemic symptoms completely resolved, and no surgical intervention was required. The median follow-up was 9 months (4-38), and all patients except insulinoma were expired during the follow-up.

Conclusions EUS-RFA is a minimally invasive and effective method with a low side effect profile for managing unresectable pancreatic tumors, NETs and associated symptoms. It can contribute to both performance status improvement and overall survival in cases of locally advanced tumors. Multicenter, prospective studies could provide better clinical outcomes regarding the efficacy of this method.

Publication History

Article published online:
27 March 2025