US-Guided Percutaneous Radiofrequency Ablation of Locally Advanced Pancreatic Adenocarcinoma: A 5-Year High-Volume Center Experience.

Published on Aug 14, 2020in Ultraschall in Der Medizin4.966
· DOI :10.1055/A-1178-0474
Mirko D'Onofrio58
Estimated H-index: 58
(University of Verona),
Alessandro Beleù3
Estimated H-index: 3
(University of Verona)
+ 7 AuthorsClaudio Bassi110
Estimated H-index: 110
(University of Verona)
Sources
Abstract
Purpose The aim of this study was to investigate the safety and effectiveness of percutaneous radiofrequency ablation (RFA) in locally advanced pancreatic cancer (LAPC) of the pancreatic body by assessing the overall survival of patients and evaluating the effects of the procedure in the clinical and radiological follow-up. Materials and Methods Patients with unresectable LAPC after failed chemoradiotherapy for at least six months were retrospectively included. Percutaneous RFA was performed after a preliminary ultrasound (US) feasibility evaluation. Contrast-enhanced computed tomography (CT) and CA 19.9 sampling were performed before and 24 hours and 30 days after the procedure to evaluate the effects of the ablation. Patients were followed-up after discharge considering the two main endpoints: procedure-related complications and death. Results 35 patients were included, 5 were excluded. All patients underwent RFA with no procedure-related complications reported. The mean size of tumors was 49 mm before treatment. The mean dimension of the ablated necrotic zone was 32 mm, with a mean extension of 65 % compared to the whole tumor size. Tumor density was statistically reduced one day after the procedure (p  Conclusion Percutaneous RFA of LAPC is a feasible technique in patients who cannot undergo surgery, with great debulking effects and a very low complication rate.
References39
Newest
#1Alessandro Beleù (University of Verona)H-Index: 3
#2Angela CalabreseH-Index: 4
Last. Mirko D'Onofrio (University of Verona)H-Index: 58
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Introduction: Evaluation of pancreatic ductal adenocarcinoma (PDAC) after chemoradiotherapy downstaging is challenging due to computed tomography (CT) overestimation of tumor extension and residual vascular involvement, limiting access to surgery to some patients with potentially resectable tumors. With this study, we wanted to assess which radiological findings are most reliable at pre-operative imaging in the evaluation of PDAC after chemoradiotherapy in order to achieve complete resection. Me...
9 CitationsSource
#1Alette H. Ruarus (VUmc: VU University Medical Center)H-Index: 8
#2Laurien G. P. H. Vroomen (VUmc: VU University Medical Center)H-Index: 13
Last. Martijn R. Meijerink (VUmc: VU University Medical Center)H-Index: 29
view all 5 authors...
Pancreatic cancer is typically characterized by its aggressive tumor growth and dismal prognosis. Approximately 30% of patients with pancreatic cancer present with locally advanced disease, broadly defined as having a tumor-to-artery interface >180°, having an unreconstructable portal vein or superior mesenteric vein and no signs of metastatic disease. These patients are currently designated to palliative systemic chemotherapy, though median overall survival remains poor (approximately 11 months...
32 CitationsSource
#1Rupen Shah (Roswell Park Cancer Institute)H-Index: 4
#1Rupen Shah (Roswell Park Cancer Institute)H-Index: 9
Last. Steven N. HochwaldH-Index: 55
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: The vast majority of patients who present with pancreatic adenocarcinoma have locally advanced or metastatic disease at the time of presentation without possibility of cure. Although in recent years there have been some new promising chemotherapy regimens that improve overall survival by a few months, the prognosis remains dismal. There is, however, a subset of patients who experience durable stable disease or partial responses after initial courses of chemotherapy with locally advanced diseas...
11 CitationsSource
#1Salvatore Paiella (University of Verona)
#1Salvatore Paiella (University of Verona)H-Index: 23
Last. Roberto Salvia (University of Verona)H-Index: 52
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Purpose SMAD4 mutational status correlates with pancreatic ductal adenocarcinoma (PDAC) failure pattern. We investigated in a subset of locally advanced patients submitted to radiofrequency ablation (RFA) whether the assessment of SMAD4 status is a useful way to select the patients.
11 CitationsSource
#1Mirko D'Onofrio (University of Verona)H-Index: 58
#2Emilio BarbiH-Index: 8
Last. Claudio BassiH-Index: 110
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Background: To evaluate the correlation between variations of CA 19.9 blood levels and the entity of necrosis at CT after radiofrequency ablation (RFA) of unresectable pancreatic adenocarcinoma. Methods: In this study, from June 2010 to February 2014, patients with diagnosis of unresectable and not metastatic pancreatic ductal adenocarcinoma, expressing tumor marker CA 19.9, treated with RFA procedure were included. All these patients underwent RFA. CT study was performed 1 week after RFA. The d...
17 CitationsSource
#1Salvatore Paiella (University of Verona)H-Index: 11
#1Salvatore Paiella (University of Verona)H-Index: 23
Last. Claudio Bassi (University of Verona)H-Index: 110
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Pancreatic ductal adenocarcinoma (PDAC) has still a dismal prognosis. Locally advanced pancreatic cancer (LAPC) accounts for the 40% of the new diagnoses. Current treatment options are based on chemo- and radiotherapy regimens. Local ablative techniques seem to be the future therapeutic option for stage-III patients with PDAC. Radiofrequency Ablation (RFA) and Irreversible Electroporation (IRE) are actually the most emerging local ablative techniques used on LAPC. Initial clinical studies on the...
41 CitationsSource
#1Kyoichi Takaori (Kyoto University)H-Index: 28
#2Claudio Bassi (University of Verona)H-Index: 110
Last. Colin D. Johnson (Southampton General Hospital)H-Index: 55
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Abstract Background Pancreatic cancer is one of the most devastating diseases with an extremely high mortality. Medical organizations and scientific societies have published a number of guidelines to address active treatment of pancreatic cancer. The aim of this consensus review was to identify where there is agreement or disagreement among the existing guidelines and to help define the gaps for future studies. Methods A panel of expert pancreatologists gathered at the 46th European Pancreatic C...
48 CitationsSource
#1Michael Linecker (UZH: University of Zurich)H-Index: 17
#2Thomas PfammatterH-Index: 30
Last. Michelle L. DeOliveiraH-Index: 16
view all 4 authors...
With the advent of novel and somewhat effective chemotherapy against pancreas cancer, several groups developed a new interest on locally advanced pancreatic cancer (LAPC). Unresectable tumors constitute up to 80% of pancreatic cancer (PC) at the time of diagnosis and are associated with a 5-year overall survival of less than 5%. To control those tumors locally, with perhaps improved patients survival, significant advances were made over the last 2 decades in the development of ablation methods i...
24 CitationsSource
#1S. RomboutsH-Index: 1
#1Steffi J.E. Rombouts (University Medical Center Utrecht)H-Index: 6
Last. I. Q. Molenaar (University Medical Center Utrecht)H-Index: 17
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Background Locally advanced pancreatic cancer (LAPC) is associated with a very poor prognosis. Current palliative (radio)chemotherapy provides only a marginal survival benefit of 2–3 months. Several innovative local ablative therapies have been explored as new treatment options. This systematic review aims to provide an overview of the clinical outcomes of these ablative therapies. Methods A systematic search in PubMed, Embase and the Cochrane Library was performed to identify clinical studies, ...
97 CitationsSource
#1Margaret G. Keane (UCL: University College London)H-Index: 13
#2Konstantinos Bramis (UCL: University College London)H-Index: 13
Last. Giuseppe Fusai (UCL: University College London)H-Index: 30
view all 4 authors...
Unresectable locally advanced pancreatic cancer with or without metastatic disease is associated with a very poor prognosis. Current standard therapy is limited to chemotherapy or chemoradiotherapy. Few regimens have been shown to have a substantial survival advantage and novel treatment strategies are urgently needed. Thermal and laser based ablative techniques are widely used in many solid organ malignancies. Initial studies in the pancreas were associated with significant morbidity and mortal...
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#1Isabella FrigerioH-Index: 17
#2Salvatore PaiellaH-Index: 23
Last. G. FiorentiniH-Index: 14
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Abstract null null Background null Local ablation of pancreatic cancer has been suggested as an option to manage locally advanced pancreatic cancer (LAPC) although no robust evidence has been published to date to support its application. The aim of this study is to compare overall survival (OS) and progression-free survival (PFS) in patients receiving both radiofrequency ablation (RFA) and conventional chemoradiotherapy (CHRT) with patients receiving CHRT only. null null null Methods null This i...
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#1Vincenza GranataH-Index: 20
#2Roberta Grassi (Seconda Università degli Studi di Napoli)H-Index: 10
Last. Francesco IzzoH-Index: 48
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BACKGROUND Currently, the technologies most commonly used to treat locally advanced pancreatic cancer are radiofrequency ablation (RFA), microwave ablation, and irreversible (IRE) or reversible electroporation combined with low doses of chemotherapeutic drugs. AIM To report an overview and updates on ablative techniques in pancreatic cancer. METHODS Several electronic databases were searched. The search covered the years from January 2000 to January 2021. Moreover, the reference lists of the fou...
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#1Salvatore Paiella (University of Verona)H-Index: 23
#2Luca Casetti (University of Verona)H-Index: 14
Last. Olivier Turrini (AMU: Aix-Marseille University)H-Index: 37
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Abstract Purpose Ablative techniques have emerged as new potential therapeutic options for patients with locally advanced pancreatic cancer (LAPC). We explored the safety and feasibility of using TRANBERG|Thermal Therapy System (Clinical Laserthermia Systems AB, Lund, Sweden) in feedback mode for immunostimulating Interstitial Laser Thermotherapy (imILT) protocol, the newest ablative technique introduced for the treatment of LAPC. Methods The safety and feasibility results after the use of imILT...
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