Long-term outcome after EUS-guided radiofrequency ablation: Prospective results in pancreatic neuroendocrine tumors and pancreatic cystic neoplasms

Abstract

Background and study aims Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) for pancreatic neuroendocrine tumors (NETs) and intraductal pancreatic mucinous neoplasia (IPMN) with worrisome features or high-risk stigmata (WF/HRS) has been evaluated in few series with short-term outcomes. This studyʼs primary endpoint was to assess the long-term efficacy of EUS-RFA in patients with NETs or pancreatic cystic neoplasms (PCNs) over at least 3 years. Patients and methods Twelve patients had 14 NETs with a mean 13.4-mm size (10–20) and 17 patients had a cystic tumor (16 IPMN, 1 MCA) with a 29.1-mm mean size (9–60 were included. They were treated with EUS-guided RFA, evaluated prospectively at 1 year, and followed annually for at least 3 years. Results The mean duration of follow-up was 42.9 months (36–53). Four patients died during follow-up (17–42 months) from unrelated diseases.At 1-year follow-up, and 85.7 % complete disappearance was seen in 12 patients with 14 NETs. At the end of follow-up (45.6 months), complete disappearance of tumors was seen in 85.7 % of cases. One case of late liver metastasis occurred in a patient with initial failure of EUS-RFA. At 1-year follow-up, a significant response was seen in 70.5 % of 15 patients with PCNs. At the end of the follow-up, there was a significant response in 66.6 % with no mural nodules. Two cases of distant pancreatic adenocarcinoma unrelated to IPMN occurred. Conclusions EUS-RFA results for pancreatic NETs or PCNs appear to be stable during 42 months of follow-up.

Endoscopic ultrasound as a reliable tool for assessment of pancreatic adenocarcinoma treatment: Example of in situ gene therapy

“…Regardless of the good agreement between investigators in terms of tumor diameter, there was also perfect agreement with regard to the antitumor effect noted in the gene therapy trial by the principal investigator 6 . Although the effect was modest and is currently being assessed on a larger scale during the Phase 2 study (Thergap-2 trial), this method is indicative of an important area of investigation in line with the EUS-guided administration of local antitumor treatments such as gene therapy, radiofrequency, and chemotherapy 6 15 16 17 18 . A centralized system, therefore, can be established for future protocols, provided that a clearly defined, standardized EUS recording is obtained.…”

Management of small, asymptomatic, non-functioning pancreatic neuroendocrine tumours: follow-up, ablation, or surgery?

“…They found that 12 of 14 lesions completely disappeared, although 2 failures were noted. One was a recurrence after the initial disappearance of the lesion after one year, and the second involved no initial response to the treatment and development of metastases [49]. The overall complication rate was 13.79%, and complications were pancreatitis, perforation in a patient with a cystic lesion, one biliary leakage, and pancreatic duct stenosis.…”

“…Radiofrequency ablation relies on delivery of a high-frequency alternating current through a needle or needle-like device, which heats the tissue and triggers tumour necrosis [46,47]. The reports describe the effectiveness of radiofrequency ablation in different types of tumours including hepatocellular carcinoma, well-differentiated thyroid, and medullary cancer [48], and different types of pancreatic tumours, including cystic neoplasms and cancer [49,50]. Current experience with EUS-guided radiofrequency ablation of NF-pNETs is limited mainly to case reports and series [51][52][53].…”

EUS-guided treatments of pancreatic cystic neoplasms – a call for methodological improvements

“…Indeed, studies on EUS-radiofrequency ablation of mural nodules within IPMNs recently reported inspiring results with 100 % effectiveness [7]. However, long-term follow-up (3 years) of these patients resulted in up to 12 % incidence of pancreatic cancer [8].…”