EUS-GUIDED RADIOFREQUENCY ABLATION OF SMALL PANCREATIC ADENOCARCINOMA: A NEW THERAPEUTIC OPTION FOR PATIENTS UNFIT FOR SURGERY

Aims:

Radiofrequency ablation (RFA) is a well-established therapeutic option for ablation of neoplastic tissue. EUS-guided RFA is a mini-invasive approach that offers a high quality real-time imaging guidance during selective ablation of pancreatic lesions. It has been demonstrated feasible and safe in patients with unresectable pancreatic cancer. We present a case of a EUS-guided RFA of a resectable small pancreatic adenocarcinoma in a patient unfit for surgery.

Methods:

A 83-year-old patient with an incidental CT-scan finding of a 15 mm solid pancreatic lesion underwent contrast-enhanced (CE) EUS. EUS revealed a 15 mm hypoechoic and hypoenhancing lesion of the neck of the pancreas with irregular borders. EUS-FNB was positive for adenocarcinoma. Despite neither vascular invasion nor distant metastases, patient was judged unfit for surgery due to multiple severe cardiovascular comorbidities. The patient was then referred for EUS-guided RFA of the lesion.

Results:

We used a novel EUS-RFA system consisting of a 19G needle electrode, a RF generator, and an internal cooling system which circulates chilled saline solution through the needle electrode during the RFA procedure to prevent charring of the surface of the electrode and improve accuracy of ablation. Lesion was punctured at two different points and a 20W ablation power was delivered at both sites under direct EUS control for 2 minutes. CE-EUS revealed no captation at an immediate post procedural evaluation. A 2 months MRI follow-up revealed a 2.4 mm avascular area assessing the presence of a RFA-related necrosis.

Conclusions:

Surgery remains the treatment of choice for resectable pancreatic adenocarcinoma. In patients unfit for surgery EUS-RFA is a feasible procedure that could represent an emerging field in unfit for surgery patients. Further studies are warranted to define the long term outcome.