EUS-GUIDED RADIOFREQUENCY ABLATION PLUS CHEMOTHERAPY VERSUS CHEMOTHERAPY ALONE FOR UNRESECTABLE PANCREATIC CANCER (ERAP): PRELIMINARY RESULTS OF A PROSPECTIVE COMPARATIVE STUDY

Aims:

To compare EUS-RFA plus chemotherapy versus chemotherapy (CMT) alone as a primary treatment of unresectable pancreatic cancer (UPC) in a prospective comparative cohort study.

Methods:

Since July 2017 until August 2018, 20 Patients (mean age 65.2 ± 11.5 years; M: F = 1: 3) at King Chulalongkorn Memorial hospital with UPC were recruited. Patients treated with EUS-RFA plus concurrent CMT (n = 10) versus CMT alone (n = 10) were classified as group A and B, respectively.

Results:

29 EUS-RFA procedures were performed with median number of procedure at 3 times (1 – 4 times), median total ablation time at 400 seconds (37 – 518 seconds), and complication rate at 10.3% (3/29). Three complications were post-procedure infection treated with intravenous antibiotic (length of stay (LOS) 7 days), bleeding from gastric wall at puncture site requiring a hemo-clip (LOS 7 days), and mild pancreatitis managed with conservative treatment (LOS 2 days). No delay of scheduled chemotherapy. Dosage reduction of morphine equivalent analgesia was significantly better in group A, 15 mg/day (0 – 60) versus 0 mg/day (-20 to 30) (p = 0.005), respectively, as well as median percentage of dosage reduction (50% (37.5 to 100) versus 0% (-100 to -42.9), p = 0.007), respectively. No enlargement of tumor measured by maximal target lesion after intervention in group A whereas in group B, both mean maximal target lesion diameter (mm) and tumor volume (ml) were statically increased after treatment (before vs. after; 53.0 ± 20.7 mm vs. 59.2 ± 16.6 mm (P = 0.039), respectively, and 76.3 ± 77.0 ml vs. 91.1 ± 83.6 ml (P = 0.014), respectively). No significant difference of 6-month survival rate between both groups.

Conclusions:

In UPC patients, EUS-RFA plus concurrent CMT could significantly reduce morphine dosage requirement for pain controlled than just given CMT. RFA additionally stabilized the tumor measured by maximal target lesion diameter and tumor volume whereas only CMT failed to halt tumor progression.