Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) for pancreatic adenocarcinoma after radiotherapy – a case report

A 77-year-old female with a history of atrial fibrillation, type 2 diabetes, and a pacemaker presented with abdominal pain, leading to a diagnosis of ductal adenocarcinoma of the pancreatic head. Imaging revealed a tumor measuring 30 x 19 mm on contrast-enhanced abdominal computed tomography (CT) and 29 x 24 mm on endoscopic ultrasound (EUS), staged as cT2N0M0 with no evidence of vascular, bile duct, or pancreatic duct invasion, and no distant metastases. Initial serum CA 19-9 level was 46.6 U/mL.

After careful evaluation of surgical risks, the patient declined pancreaticoduodenectomy and chemotherapy. Five months later, she underwent EUS-guided placement of platinum fiducial markers into the tumor, followed by external beam radiotherapy (40 Gy to the tumor site, 33 Gy to surrounding margins). A follow-up CT scan at 6 months showed a reduction in tumor size to 27 x 17 mm, with CA 19-9 decreasing to 34.4 U/mL [1] [2] [3] [4] [5].

After 8 months, the patient was referred for EUS-guided radiofrequency ablation (RFA) at the University Hospital in Krakow. Following approval by the institutional bioethics committee, RFA was performed 3 months later using a 10-mm needle (EUSRA) at a power setting of 50 W. At the 14-month post-radiotherapy and 4-month post-RFA follow-up 3 months later, the tumor had reduced by approximately 30% (CT: 20 x 15 mm; EUS: 20 x 12 mm), and CA 19-9 level normalized to 17.4 U/mL. There was no evidence of disease progression or metastasis, and the patient reported no significant side effects or deterioration in quality of life.

Publication History

Article published online:
27 March 2025

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