Endoscopic ultrasound-guided radiofrequency ablation extends survival in PDAC
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CHARLOTTE, N.C. — Endoscopic ultrasound-guided radiofrequency ablation, alone or combined with chemotherapy, improved survival and progression-free survival among a small subset of patients with primary pancreatic ductal adenocarcinoma.
“The current treatment for primary pancreatic ductal adenocarcinoma relies on systemic therapy and, unfortunately, approximately 80% of patients will be deemed unresectable at the time of diagnosis,” Chawin Lopimpisuth, MD, of King Chulalongkorn Memorial Hospital in Bangkok, told attendees at the ACG Annual Scientific Meeting. “The American Society of Clinical Oncology recommends unresectable cases should seek treatment and be offered the information about clinical trials and current treatment that’s still being researched.
“The potential use of endoscopic ultrasound-guided radiofrequency ablation provides a treatment option,” he continued. “Previous studies also show promising feasibility and safety. However, clinical effects, such as survival time, progression-free period and radiological change are still unclear and erratically reported.”
In a prospective study, Lopimpisuth and colleagues examined clinical outcomes and survival rates among 11 patients (mean age, 63 years; 82% women) with unresectable pancreatic ductal adenocarcinoma (PDAC; primary tumor size 4 cm) who underwent endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA). Patients were matched with 35 historical controls (mean age, 68 years; 63% women).
Tumor size, staging, age-adjusted Charleston Comorbidity Index (CCI), chemotherapy regimen and interactions between CCI regimen and staging determined propensity score. Researchers monitored patients for at least 12 months to establish survival rates.
According to study results, medial weighted survival was 14 months in the EUS-RFA group compared with 6.1 months in the control group; adjusted survival probability at 6 months was 73% vs. 69%, respectively, and 64% vs. 17% at 12 months (HR = 0.38; 95% CI, 0.17-0.84). Median weighted time to progression was 6.1 months vs. 3.9 months and adjusted progression-free survival at 6 and 12 months was 55% vs. 28% and 36% vs. 4%, respectively (HR = 0.57; 95% CI, 0.36-1.26).
“Further studies are required to answer more about these concepts,” Lopimpisuth said, noting the study’s case-control design and relatively small population.
He concluded, “It is possible that in patients with unresectable pancreatic ductal adenocarcinoma, whose tumor size is less than 4 cm, that EUS-RFA alone or combined with chemotherapy resulted in significantly improved survival and tended to improve progression-free survival with minimal adverse event.”
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Lopimpisuth C, et al. Abstract S1066: High 1-year survival rate of unresectable pancreatic cancer size smaller than 4 cm in diameter treated with concurrent EUS-RFA: An average treatment effect on the treated weighted survival analysis, Presented at: ACG Annual Scientific Meeting; Oct. 21-26, 2022; Charlotte, N.C. (hybrid meeting).
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