Endoscopic Ultrasound-guided Radiofrequency Ablation for Pancreatic Adenocarcinoma

Abstract INTRODUCTIONEmerging data suggests neoadjuvant chemotherapy for resectable pancreatic ductal adenocarcinoma (PDAC) is associated with improved survival. However, less than 40% demonstrate a meaningful radiographic response to NAC. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has emerged as a new modality to treat PDAC. We hypothesize that NAC plus EUS-RFA can be used in the management of resectable PDAC.METHODSProspective review of PDAC patients meeting criteria of resectable tumor anatomy that underwent NAC chemotherapy plus EUS-RFA followed by pancreatic resection. Radiographic imaging, perioperative and short-term outcomes were recorded. Surgical pathology specimens were analyzed for treatment response.RESULTSThree eligible patients with resectable PDAC received 4 months of neoadjuvant chemotherapy plus EUS-RFA. One month after completion of neoadjuvant treatment, all 3 patients underwent standard pancreaticoduodenectomy without complications. After a 6 week recovery, all patients completed 2 months of post-op adjuvant chemotherapy.CONCLUSIONSIn our institutional experience, this treatment protocol appears safe. Patients tolerated the combination of chemotherapy and endoscopic radiofrequency ablation. Patients underwent pancreatic resection with uneventful recovery. This novel neoadjuvant approach may provide a more effective alternative to chemotherapy alone.