Robles-Medranda Carlos, Del Valle Raquel, Puga-Tejada Miguel, Arevalo-Mora Martha, Cunto Domenica, Egas-Izquierdo Maria, Estrada-Guevara Lorena, Bunces-Orellana Orlando, Moreno-Zambrano Daniel, Alcivar-Vasquez Juan, Alvarado-Escobar Haydee, Merfea Ruxandra C, Barreto-Perez Jonathan, Rodriguez Jorge, Calle-Loffredo Daniel, Pitanga-Lukashok Hannah, Baquerizo-Burgos Jorge, Tabacelia Daniela
Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador.
Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia.
Gastrointest Endosc. 2024 Aug;100(2):250-258. doi: 10.1016/j.gie.2024.03.023. Epub 2024 Mar 20.
EUS-guided radiofrequency ablation (EUS-RFA) has emerged as an alternative for the local treatment of unresectable pancreatic ductal adenocarcinoma (PDAC). We assessed the feasibility and safety of EUS-RFA in patients with unresectable PDAC.
This study followed an historic cohort compounded by locally advanced (LA-) and metastatic (m)PDAC-naïve patients who underwent EUS-RFA between October 2019 and March 2022. EUS-RFA was performed with a 19-gauge needle electrode with a 10-mm active tip for energy delivery. Study primary endpoints were feasibility, safety, and clinical follow-up, whereas secondary endpoints were performance status (PS), local control, and overall survival (OS).
Twenty-six patients were selected: 15 with locally advanced pancreatic duct adenocarcinoma (LA-PDAC) and 11 with metastatic pancreatic duct adenocarcinoma (mPDAC). Technical success was achieved in all patients with no major adverse events. Six months after EUS-RFA, OS was seen in 11 of 26 patients (42.3%), with significant PS improvement (P = .03). Local control was achieved, with tumor reduction from 39.5 mm to 26 mm (P = .04). A post-treatment hypodense necrotic area was observed at the 6-month follow-up in 11 of 11 patients who were still alive. Metastatic disease was a significant factor for worsening OS (hazard ratio, 5.021; 95% confidence interval, 1.589-15.87; P = .004).
EUS-RFA for the treatment of pancreatic adenocarcinoma is a minimally invasive and safe technique that may have an important role as targeted therapy for local treatment of unresectable cases and as an alternative for poor surgical candidates. Also, RFA may play a role in downstaging cancer with a potential increase in OS in nonmetastatic cases. Large prospective cohorts are required to evaluate this technique in clinical practice.
超声内镜引导下射频消融术（EUS-RFA）已成为不可切除胰腺导管腺癌（PDAC）局部治疗的一种替代方法。我们评估了EUS-RFA在不可切除PDAC患者中的可行性和安全性。
本研究纳入了2019年10月至2022年3月期间接受EUS-RFA的局部晚期（LA-）和初治转移性（m）PDAC患者组成的历史性队列。使用带有10毫米活性尖端的19号针电极进行EUS-RFA以输送能量。研究的主要终点是可行性、安全性和临床随访，而次要终点是体能状态（PS）、局部控制和总生存期（OS）。
共入选26例患者：15例局部晚期胰腺导管腺癌（LA-PDAC）患者和11例转移性胰腺导管腺癌（mPDAC）患者。所有患者均取得技术成功，无重大不良事件。EUS-RFA术后6个月，26例患者中有11例（42.3%）存活，PS有显著改善（P = 0.03）。实现了局部控制，肿瘤大小从39.5毫米缩小至26毫米（P = 0.04）。在6个月随访时，11例仍存活患者中有11例观察到治疗后低密度坏死区。转移性疾病是OS恶化的一个重要因素（风险比，5.021；95%置信区间，1.589 - 15.87；P = 0.004）。
EUS-RFA治疗胰腺腺癌是一种微创且安全的技术，对于不可切除病例的局部治疗作为靶向治疗以及对于手术条件差的患者作为替代治疗可能具有重要作用。此外，RFA可能在肿瘤降期方面发挥作用，在非转移性病例中可能潜在地提高OS。需要大型前瞻性队列来在临床实践中评估该技术。
