Radiofrequency ablation of pancreatic ductal adenocarcinoma: The past, the present and the future

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive cancers with a grim overall 5-year survival rate of 5%. Advances in surgical techniques, critical care, molecular diagnosis, diagnostic imaging, endosonology and adjuvant therapy have improved outcomes; but still more needs to be achieved. There is an urgent need to discover new avenues that may impact survival. Radiofrequency ablation (RFA) has attracted attention as an adjunctive treatment in PDAC. A review of English literature in PubMed was done using the MESH terms for PDAC and RFA. All the articles were reviewed and core information was tabulated for reference. After a comprehensive review of all articles the data was evaluated to discover the role of RFA in PDAC management. Indications, contraindications, feasibility, success rate, safety, complications and impact on survival were reviewed and are discussed further. RFA appears to be an attractive option for non-metastatic locally advanced PDAC. RFA is feasible but has a significant morbidity. At the present time the integration of RFA into the management of pancreatic ductal adenocarcinoma is evolving. It should be considered as having a complimentary role to current standard therapy in the multimodal management care model. It is likely that indications and patient selection for pancreatic RFA will expand.

The clinical benefit of hyperthermia in pancreatic cancer: a systematic review

“…The combination of gemcitabine and nab-paclitaxel showed improved survival over gemcitabine monotherapy in patients with metastatic pancreatic cancer [19,20]. For localised disease, encouraging results from stereotactic body radiation therapy (SBRT), radiofrequency ablation (RFA) and irreversible electroporation (IRE) have been reported, though evidence from randomised trials is still lacking [21][22][23][24]. However, the aforementioned treatments are often taxing to the patient, have high toxicity rates, or are still lacking evidence of efficacy.…”

Radiofrequency Ablation of Pancreatic Cancer

“…Pancreatic adenocarcinoma is one of the most aggressive cancers with a 5-year overall survival of approximately 5%. 33,34 It represents the most common malignancy of the pancreas and at the time of diagnosis only in the 20% of cases it is eligible for surgical intervention. The other 80% is represented by metastatic disease and by locally advanced pancreatic cancer (LAPC).…”

Endoscopic Ultrasound-Guided Treatment of Pancreatic Cystic and Solid Masses

“…It is recognized as one of the least invasive therapeutic options for pancreatic cancer. 1 19 20 However, it should be considered that the pancreas is different from other organs, especially the liver. The first difference is that the physical properties of the pancreas are different from those of the liver and therefore, the RFA protocol for the liver cannot be used in the pancreas.…”

“…There have been many ex vivo and in vivo studies to determine the optimal thermal kinetic characteristics; however, there is still no standardized protocol for pancreatic RFA. 20 The second difference is in its location. The pancreas, especially the head, is surrounded by the stomach, duodenum, portal vein, superior mesenteric vessels, and bile duct, and as such pancreatic RFA has a risk of thermal injury to surrounding organs.…”