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Ultraschall Med 2022; 43(04): 380-386
DOI: 10.1055/a-1178-0474
Original Article

US-Guided Percutaneous Radiofrequency Ablation of Locally Advanced Pancreatic Adenocarcinoma: A 5-Year High-Volume Center Experience

US-gesteuerte perkutane Radiofrequenzablation beim lokal fortgeschrittenen Pankreas-Adenokarzinom: 5-jährige Erfahrung eines Zentrums mit hohem Patientenaufkommen
Mirko D’Onofrio
1   Radiology, University of Verona, Italy
,
Alessandro Beleù
1   Radiology, University of Verona, Italy
,
Alessandro Sarno
1   Radiology, University of Verona, Italy
,
Riccardo De Robertis
1   Radiology, University of Verona, Italy
,
Salvatore Paiella
2   Surgery, University of Verona, Italy
,
Elena Viviani
2   Surgery, University of Verona, Italy
,
Isabella Frigerio
3   Surgery, Pederzoli Hospital Private Clinic SpA, Peschiera del Garda, Italy
,
Roberto Girelli
3   Surgery, Pederzoli Hospital Private Clinic SpA, Peschiera del Garda, Italy
,
Roberto Salvia
2   Surgery, University of Verona, Italy
,
Claudio Bassi
2   Surgery, University of Verona, Italy
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Abstract

Purpose The aim of this study was to investigate the safety and effectiveness of percutaneous radiofrequency ablation (RFA) in locally advanced pancreatic cancer (LAPC) of the pancreatic body by assessing the overall survival of patients and evaluating the effects of the procedure in the clinical and radiological follow-up.

Materials and Methods Patients with unresectable LAPC after failed chemoradiotherapy for at least six months were retrospectively included. Percutaneous RFA was performed after a preliminary ultrasound (US) feasibility evaluation. Contrast-enhanced computed tomography (CT) and CA 19.9 sampling were performed before and 24 hours and 30 days after the procedure to evaluate the effects of the ablation. Patients were followed-up after discharge considering the two main endpoints: procedure-related complications and death.

Results 35 patients were included, 5 were excluded. All patients underwent RFA with no procedure-related complications reported. The mean size of tumors was 49 mm before treatment. The mean dimension of the ablated necrotic zone was 32 mm, with a mean extension of 65 % compared to the whole tumor size. Tumor density was statistically reduced one day after the procedure (p < 0.001). The mean CA 19.9 levels before and 24 hours and 30 days after the procedure were 285.8 U/mL, 635.2 U/mL, and 336.0 U/mL, respectively, with a decrease or stability at the 30-day evaluation in 80 % of cases. The mean survival was 310 (65–718) days.

Conclusion Percutaneous RFA of LAPC is a feasible technique in patients who cannot undergo surgery, with great debulking effects and a very low complication rate.

Zusammenfassung

Ziel Ziel dieser Studie war es, die Sicherheit und Wirksamkeit der perkutanen Radiofrequenzablation (RFA) bei lokal fortgeschrittenem Pankreaskarzinom (LAPC) zu untersuchen, indem das Gesamtüberleben der Patienten beurteilt wurde und die Auswirkungen des Verfahrens in der klinischen und radiologischen Nachsorge bewertet wurden.

Material und Methoden Patienten mit inoperablem LAPC nach fehlgeschlagener Radiochemotherapie über mindestens 6 Monate wurden retrospektiv eingeschlossen. Die perkutane RFA wurde nach einer vorläufigen Ultraschall (US)-Machbarkeitsbewertung durchgeführt. Eine kontrastverstärkte Computertomografie (CT) und eine Probenentnahme für CA 19-9 wurden vor dem Verfahren und 24 Stunden sowie 30 Tage danach durchgeführt, um die Auswirkungen der Ablation zu beurteilen. Die Patienten wurden nach Entlassung unter Berücksichtigung der beiden wichtigsten Endpunkte nachbeobachtet: verfahrensbedingte Komplikationen und Tod.

Ergebnisse Es wurden 35 Patienten eingeschlossen und 5 ausgeschlossen. Alle Patienten wurden der RFA unterzogen, wobei keine verfahrensbezogenen Komplikationen gemeldet wurden. Die durchschnittliche Tumorgröße betrug vor der Behandlung 49 mm. Das mittlere Ausmaß der abgetragenen nekrotischen Zone betrug 32 mm, mit einer mittleren Ausdehnung von 65 % im Vergleich zur gesamten Tumorgröße. Die Tumordichte war einen Tag nach dem Eingriff statistisch signifikant reduziert (p < 0,001). Die mittleren CA-19-9-Werte vor dem Eingriff und 24 Stunden bzw. 30 Tage danach betrugen 285,8 U/ml, 635,2 U/ml bzw. 336,0 U/ml, mit einer Abnahme oder Stabilität der Werte in der 30-Tage-Auswertung bei 80 % der Fälle. Die mittlere Überlebenszeit betrug 310 (65–718) Tage.

Schlussfolgerung Die perkutane RFA der LAPC ist eine durchführbare Technik bei Patienten, die nicht operiert werden können, mit großen Debulking-Effekten und einer sehr niedrigen Komplikationsrate.

Key words

pancreatic cancer - radiofrequency ablation - interventional radiology - percutaneous procedures - ultrasound

Supplement



Publication History

Received: 02 October 2019

Accepted: 04 May 2020

Article published online:
14 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 O’Connor TP, Wade TP, Sunwoo YC. et al. Small cell undifferentiated carcinoma of the pancreas. Report of a patient with tumor marker studies. Cancer 1992; 70: 1514-1519
    CrossrefPubMedGoogle Scholar
  • 2 Schima W, Ba-Ssalamah A, Kolblinger C. et al. Pancreatic adenocarcinoma. Eur Radiol 2007; 17: 638-649
    CrossrefPubMedGoogle Scholar
  • 3 Verslype C, Van Cutsem E, Dicato M. et al. The management of pancreatic cancer. Current expert opinion and recommendations derived from the 8th World Congress on Gastrointestinal Cancer, Barcelona, 2006. Ann Oncol Off J Eur Soc Med Oncol 2007; 18 (Suppl. 07) vii1-vii10
    PubMedGoogle Scholar
  • 4 Frigerio I, Girelli R, Giardino A. et al. Short term chemotherapy followed by radiofrequency ablation in stage III pancreatic cancer: results from a single center. J Hepatobiliary Pancreat Sci 2013; 20: 574-577
    CrossrefPubMedGoogle Scholar
  • 5 Neoptolemos JP, Stocken DD, Friess H. et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004; 350: 1200-1210
    CrossrefPubMedGoogle Scholar
  • 6 Tempero MA, Malafa MP, Chiorean EG. et al. Pancreatic Adenocarcinoma, Version 1.2019. J Natl Compr Canc Netw 2019; 17: 202-210
    CrossrefPubMedGoogle Scholar
  • 7 Gillen S, Schuster T, Meyer Zum Buschenfelde C. et al. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med 2010; 7: e1000267
    CrossrefPubMedGoogle Scholar
  • 8 Beleù A, Calabrese A, Rizzo G. et al. Preoperative Imaging Evaluation after Downstaging of Pancreatic Ductal Adenocarcinoma: A Multi-Center Study. Cancers (Basel) 2019; 11: 267
    CrossrefPubMedGoogle Scholar
  • 9 Casadei R, Ricci C, Pezzilli R. et al. A prospective study on radiofrequency ablation locally advanced pancreatic cancer. Hepatobiliary Pancreat Dis Int 2010; 9: 306-311
    PubMedGoogle Scholar
  • 10 Girelli R, Frigerio I, Salvia R. et al. Feasibility and safety of radiofrequency ablation for locally advanced pancreatic cancer. Br J Surg 2010; 97: 220-225
    CrossrefPubMedGoogle Scholar
  • 11 D’Onofrio M, Barbi E, Girelli R. et al. Radiofrequency ablation of locally advanced pancreatic adenocarcinoma: an overview. World J Gastroenterol 2010; 16: 3478-3483
    CrossrefPubMedGoogle Scholar
  • 12 Giardino A, Girelli R, Frigerio I. et al. Triple approach strategy for patients with locally advanced pancreatic carcinoma. HPB (Oxford) 2013; 15: 623-627
    CrossrefPubMedGoogle Scholar
  • 13 D’Onofrio M, Barbi E, Girelli R. et al. Variation of tumoral marker after radiofrequency ablation of pancreatic adenocarcinoma. J Gastrointest Oncol 2016; 7: 213-220
    PubMedGoogle Scholar
  • 14 Paiella S, Salvia R, Ramera M. et al. Local Ablative Strategies for Ductal Pancreatic Cancer (Radiofrequency Ablation, Irreversible Electroporation): A Review. Gastroenterol Res Pract 2016; 2016: 4508376
    CrossrefPubMedGoogle Scholar
  • 15 D’Onofrio M, Beleù A, De Robertis R. Ultrasound-guided percutaneous procedures in pancreatic diseases: new techniques and applications. Eur Radiol Exp 2019; 3: 2
    PubMedGoogle Scholar
  • 16 Linecker M, Pfammatter T, Kambakamba P. et al. Ablation Strategies for Locally Advanced Pancreatic Cancer. Dig Surg 2016; 33: 351-359
    CrossrefPubMedGoogle Scholar
  • 17 Rombouts SJE, Vogel JA, van Santvoort HC. et al. Systematic review of innovative ablative therapies for the treatment of locally advanced pancreatic cancer. Br J Surg 2015; 102: 182-193
    CrossrefPubMedGoogle Scholar
  • 18 Rovere-Querini P, Manfredi AA. Tumor destruction and in situ delivery of antigen presenting cells promote anti-neoplastic immune responses: implications for the immunotherapy of pancreatic cancer. JOP 2004; 5: 308-314
    PubMedGoogle Scholar
  • 19 Haen SP, Pereira PL, Salih HR. et al. More than just tumor destruction: immunomodulation by thermal ablation of cancer. Clin Dev Immunol 2011; 2011: 160250
    PubMedGoogle Scholar
  • 20 Keane MG, Bramis K, Pereira SP. et al. Systematic review of novel ablative methods in locally advanced pancreatic cancer. World J Gastroenterol 2014; 20: 2267-2278
    CrossrefPubMedGoogle Scholar
  • 21 Shah R, Ostapoff KT, Kuvshinoff B. et al. Ablative Therapies for Locally Advanced Pancreatic Cancer. Pancreas 2018; 47: 6-11
    CrossrefPubMedGoogle Scholar
  • 22 Girelli R, Frigerio I, Giardino A. et al. Results of 100 pancreatic radiofrequency ablations in the context of a multimodal strategy for stage III ductal adenocarcinoma. Langenbeck’s Arch Surg 2013; 398: 63-69
    CrossrefPubMedGoogle Scholar
  • 23 Cantore M, Girelli R, Mambrini A. et al. Combined modality treatment for patients with locally advanced pancreatic adenocarcinoma. Br J Surg 2012; 99: 1083-1088
    CrossrefPubMedGoogle Scholar
  • 24 Paiella S, Malleo G, Cataldo I. et al. Radiofrequency ablation for locally advanced pancreatic cancer: SMAD4 analysis segregates a responsive subgroup of patients. Langenbeck’s Arch Surg 2018; 403: 213-220
    PubMedGoogle Scholar
  • 25 Takaori K, Bassi C, Biankin A. et al. International Association of Pancreatology (IAP)/European Pancreatic Club (EPC) consensus review of guidelines for the treatment of pancreatic cancer. Pancreatology 2016; 16: 14-27
    CrossrefPubMedGoogle Scholar
  • 26 Eisenhauer EA, Therasse P, Bogaerts J. et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45: 228-247
    CrossrefPubMedGoogle Scholar
  • 27 Clavien PA, Barkun J, de Oliveira ML. et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250: 187-196
    CrossrefPubMedGoogle Scholar
  • 28 Siegel R, Ma J, Zou Z. et al. Cancer statistics, 2014. CA Cancer J Clin 2014; 64: 9-29
    Google Scholar
  • 29 Baxter NN, Whitson BA, Tuttle TM. Trends in the treatment and outcome of pancreatic cancer in the United States. Ann Surg Oncol 2007; 14: 1320-1326
    CrossrefPubMedGoogle Scholar
  • 30 Kovach SJ, Hendrickson RJ, Cappadona CR. et al. Cryoablation of unresectable pancreatic cancer. Surgery 2002; 131: 463-464
    CrossrefPubMedGoogle Scholar
  • 31 Embuscado EE, Laheru D, Ricci F. et al. Immortalizing the complexity of cancer metastasis: genetic features of lethal metastatic pancreatic cancer obtained from rapid autopsy. Cancer Biol Ther 2005; 4: 548-554
    CrossrefPubMedGoogle Scholar
  • 32 Hadjicostas P, Malakounides N, Varianos C. et al. Radiofrequency ablation in pancreatic cancer. HPB (Oxford) 2006; 8: 61-64
    CrossrefPubMedGoogle Scholar
  • 33 Waitz R, Solomon SB. Can local radiofrequency ablation of tumors generate systemic immunity against metastatic disease?. Radiology 2009; 251: 1-2
    CrossrefPubMedGoogle Scholar
  • 34 Dallal RM, Christakos P, Lee K. et al. Paucity of dendritic cells in pancreatic cancer. Surgery 2002; 131: 135-138
    CrossrefPubMedGoogle Scholar
  • 35 Teng LS, Jin KT, Han N. et al. Radiofrequency ablation, heat shock protein 70 and potential anti-tumor immunity in hepatic and pancreatic cancers: a minireview. Hepatobiliary Pancreat Dis Int 2010; 9: 361-365
    PubMedGoogle Scholar
  • 36 Muerkoster S, Wegehenkel K, Arlt A. et al. Tumor stroma interactions induce chemoresistance in pancreatic ductal carcinoma cells involving increased secretion and paracrine effects of nitric oxide and interleukin-1beta. Cancer Res 2004; 64: 1331-1337
    CrossrefPubMedGoogle Scholar
  • 37 Wu Y, Tang Z, Fang H. et al. High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer. J Surg Oncol 2006; 94: 392-395
    CrossrefPubMedGoogle Scholar
  • 38 Ng KKC, Lam CM, Poon RTP. et al. Delayed portal vein thrombosis after experimental radiofrequency ablation near the main portal vein. Br J Surg 2004; 91: 632-639
    CrossrefPubMedGoogle Scholar
  • 39 Ng KKC, Lam CM, Poon RTP. et al Portal vein thrombosis after radiofrequency ablation for recurrent hepatocellular carcinoma. Asian J Surg 2003; 26: 50-53 ; discussion 54
    CrossrefPubMedGoogle Scholar
  • 40 Tang Z, Wu YL, Fang HQ. et al. Treatment of unresectable pancreatic carcinoma by radiofrequency ablation with ‘cool-tip needle’: report of 18 cases. Zhonghua Yi Xue Za Zhi 2008; 88: 391-394
    PubMedGoogle Scholar
  • 41 Heinemann V, Haas M, Boeck S. Neoadjuvant treatment of borderline resectable and non-resectable pancreatic cancer. Ann Oncol Off J Eur Soc Med Oncol 2013; 24: 2484-2492
    CrossrefPubMedGoogle Scholar
  • 42 Ruarus A, Vroomen L, Puijk R. et al. Locally Advanced Pancreatic Cancer: A Review of Local Ablative Therapies. Cancers (Basel) 2018; 10: 16
    CrossrefPubMedGoogle Scholar
  • 43 Spiliotis JD, Datsis AC, Michalopoulos NV. et al. Radiofrequency ablation combined with palliative surgery may prolong survival of patients with advanced cancer of the pancreas. Langenbeck’s Arch Surg 2007; 392: 55-60
    CrossrefPubMedGoogle Scholar