Short term chemotherapy followed by radiofrequency ablation in stage III pancreatic cancer: results from a single center

Abstract

Background Neo-adjuvant chemotherapy (CHT) has gained increasing importance in resectable and borderline resectable pancreatic cancer leading to a better performing surgery when we look at negative resection margins and selection of patients with less aggressive disease. We apply this principle to patients with Stage III (LAC) pancreatic cancer undergoing RFA and try to select patients who may benefit from a local treatment. Methods All patients affected by LAC were treated with RFA for a stable disease after a short CHT. Postoperative morbidity and mortality were evaluated together with overall survival (OS) and disease specific survival (DSS). Results We consecutively treated 57 patients affected by LAC. Median duration of CHT before RFA was 5 months. The postoperative mortality rate was zero. Overall morbidity was 14 % with RFA-related morbidity of 3.5 %. The OS and DSS were 19 months and when compared to a similar population who received RFA as up front treatment, there was no difference. Conclusions Our results do not support the adoption of a short CHT as a way to identify patients to treat with RFA with the most benefit. Based on this and by knowing the role of immune modulation after RFA and its specific involvement in pancreatic carcinoma, we can propose RFA as upfront treatment.

Safety and Feasibility of Irreversible Electroporation (IRE) in Patients with Locally Advanced Pancreatic Cancer: Results of a Prospective Study

“…Moreover, the majority of these tumors are unresectable at the time of diagnosis, with a high percentage of locally advanced disease. While protocols including chemotherapy and chemoradiotherapy frequently lead to disappointing results, the use of ablative techniques, such as radiofrequency ablation, on pancreatic neoplasms seem to provide encouraging results even if they are associated with serious heat-related complications, as reported by Frigerio et al [29,30,31] . The present study was designed to evaluate the safety and feasibility of IRE in ten patients with cytohystological diagnosis of LAPC.…”

Systematic review of innovative ablative therapies for the treatment of locally advanced pancreatic cancer

“…A total of seven clinical studies were included of which four were prospective and two retrospective; one study did not report on the design ( Table S , supporting information). Four studies used a RITA® System Generator 1500X (AngioDynamics, Latham, New York, USA) and StarBurst™ XL multiarray probes (RITA Medical Systems, Mountain View, California, USA). Two other studies used the Cool‐tip™ RFA ablation system and Cool‐tip™ Cluster electrodes (Integra Radionics, Burlington, Massachusetts, USA).…”

“…Five studies reported on long‐term survival after RFA of the pancreas for LAPC, with median survival ranging from 5·0 to 25·6 months. Spiliotis and co‐workers reported a median survival between 13 and 19 months for eight patients treated with RFA and bypass surgery, and showed an improvement in survival following RFA of the pancreas compared with that in nine patients receiving best supportive care.…”

“…A total of seven clinical studies were included of which four were prospective 28 -31 and two retrospective 32,33 ; one study 34 did not report on the design (Table S1, supporting information). Four studies 28 30 107…”

Are There Indications for Total Pancreatectomy in 2016?

“…However, it is probable that we will also get better imaging of small pancreatic lesions, thus picking out those cystic - and other pancreatic tumors - that might be malignant. Also, it is most probable that we will learn how to destruct small pancreatic tumors without open surgery (e.g., by radiofrequency ablation) [33] and in a somewhat longer perspective even treat premalignant lesions and turn them into benign lesions by pharmacological means. In this scenario, the number of total pancreatectomies will almost vanish again, except for the advanced pancreatic adenocarcinomas and the rescue pancreatectomies after leaking pancreatoenteric anastomoses.…”