Advances in radiofrequency ablation for pancreatic cancer

Abstract

Radiofrequency ablation (RFA), particularly endoscopic ultrasound-guided RFA (EUS-RFA), has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer, especially in patients with locally advanced or unresectable disease. This review outlines recent technological developments in EUS-RFA, including innovations in energy delivery systems, probe design, and real-time thermal monitoring, which have improved the precision and safety of the procedure. Clinical studies combining EUS-RFA with chemotherapy have demonstrated encouraging outcomes, with improvements in overall survival, progression-free survival, tumor necrosis, and symptom control compared to chemotherapy alone. Additionally, RFA-induced tumor antigen release and modulation of the tumor microenvironment suggest a potential synergistic role with immunotherapy. Despite its promise, the widespread adoption of EUS-RFA is limited by a lack of large-scale randomized controlled trials and standardized treatment protocols.

Key Words: Pancreatic cancer; Endoscopic ultrasound-guided radiofrequency ablation; Radiofrequency ablation; Combination therapy; Chemotherapy; Immunotherapy

Core Tip: This article highlights the evolving role of endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) in the treatment of pancreatic cancer. Advances in energy delivery, probe design, and real-time imaging have enhanced the safety and precision of EUS-RFA. When combined with chemotherapy, EUS-RFA shows promise in improving survival outcomes and symptom control. Moreover, its immunomodulatory effects offer a novel rationale for combination with immunotherapy. Despite encouraging results, further randomized trials and standardization of protocols are needed to establish EUS-RFA as a mainstream component of pancreatic cancer treatment.

INTRODUCTION

Pancreatic cancer is widely regarded as one of the most aggressive and challenging malignancies to treat, primarily due to its insidious onset and rapid progression[1]. In many cases, by the time of diagnosis, the disease has already advanced to a stage where surgical resection is no longer a viable option[2]. This late-stage diagnosis is partly due to the deep anatomical location of the pancreas and the lack of specific early symptoms, making early detection difficult. The prognosis for patients with locally advanced or unresectable pancreatic cancer remains exceedingly poor[3]. Despite significant progress in systemic therapies, such as chemotherapy, radiation therapy, and targeted treatments, these modalities often fail to produce durable responses, and the disease frequently recurs even after initial treatment[4]. Furthermore, the limited efficacy of these therapies is compounded by the tumor's intrinsic resistance mechanisms and the highly desmoplastic, immunosuppressive microenvironment that characterizes pancreatic cancer[5]. In response to these challenges, minimally invasive techniques like radiofrequency ablation (RFA) have gained attention as potential adjuncts or alternatives to traditional treatment modalities[6]. Among these, endoscopic ultrasound-guided RFA (EUS-RFA) has emerged as a particularly promising option, offering a less invasive approach with the ability to target tumors that are otherwise inaccessible by surgery or conventional therapies[7]. EUS-RFA involves the application of high-frequency radio waves to targeted tumor tissues, leading to thermal coagulation and necrosis. This technique is based on the principle that controlled heat generation can destroy malignant cells while minimizing damage to surrounding healthy tissues. The core therapeutic concept behind EUS-RFA is to reduce tumor size, alleviate symptoms, and improve local control of the disease. EUS-RFA is especially valuable for patients with locally advanced or borderline resectable pancreatic cancer, where other therapeutic options may be limited due to the tumor’s location, size, or the patient's frailty[8]. This review aims to provide a comprehensive overview of the advancements in EUS-RFA technology, including energy delivery systems in EUS-RFA, probe designs and thermal monitoring in EUS-RFA, and real-time imaging in EUS-RFA (Table 1). Furthermore, combination therapy with systemic treatment, and immunomodulatory effects and potential for immunotherapy were discussed. Finally, the review addresses the challenges and future directions for pancreatic cancer.

Table 1 Representative technological advances in endoscopic ultrasound-guided radiofrequency ablation for pancreatic cancer.

Technology	Year	Study design	Sample size/population	Key outcomes	Advances	Ref.
Energy delivery systems	2021	Retrospective cohort	11 patients with unresectable PDAC	100% technical success	Low-power monopolar RFA (5-10 W for 90 seconds per session)	Wang et al[10]
				Tumor size reduction observed in post-op imaging	Multiple sessions (up to 8)
				5/11 patients had CA19-9 reduction	Fine-gauge (19G) RFA needle used to reduce collateral damage
				No major adverse events
Probe designs	2024	Historic single-center cohort	26 patients with unresectable PDAC	100% technical success	High-precision 19G RFA needle with 10-mm active tip	Robles-Medranda et al[16]
				Tumor size reduced from 39.5 mm to 26 mm at 6 months (P = 0.04)	Use of steerable, slim electrodes for better access to tumors near vessels or GI wall
				OS at 6 months: 42.3%	Thermally insulated shaft to minimize injury
				Significant PS improvement
Real-time imaging	2022	Prospective cohort (longitudinal)	10 patients with locally advanced/metastatic PDAC	22 total EUS-RFA sessions across 10 patients	EUS-guided real-time imaging used in all stages (needle placement, ablation monitoring, post-procedure follow-up)	Thosani et al[28]
				Median survival: 20.5 months	Multiple oblique imaging planes used to assess margins
				> 50% tumor regression in 3 patients	Ablation near vascular structures guided with high-resolution Doppler modes
				2 patients alive at 61 and 81 months

PDAC: Pancreatic ductal adenocarcinoma; RFA: Radiofrequency ablation; OS: Overall survival; GI: Gastrointestinal; EUS-RFA: Endoscopic ultrasound-guided radiofrequency ablation; EUS: Endoscopic ultrasound.

INNOVATIONS IN POSITIONING ACCURACY, THERMAL MONITORING, AND REAL-TIME IMAGING

Recent innovations in positioning accuracy, thermal monitoring technology, and real-time imaging have significantly improved the effectiveness and precision of EUS-RFA. Accurate probe positioning is essential to ensure the targeted delivery of energy to the tumor while minimizing damage to surrounding healthy tissues. Advances in imaging technologies, particularly in real-time ultrasound and high-resolution imaging, have enhanced the ability to visualize tumors and surrounding structures in greater detail, allowing for more precise needle placement and energy delivery. Furthermore, innovations in thermal monitoring have enabled continuous tracking of tissue temperature during the procedure, ensuring that the optimal temperature for tumor ablation is reached without causing excessive damage to adjacent tissues. This real-time feedback is crucial for improving both the safety and effectiveness, particularly in complex cases where the tumor is located near vital structures such as blood vessels or the duodenum. Building on these diagnostic and imaging advancements, subsequent improvements in therapeutic techniques have enhanced the overall precision.

ENERGY DELIVERY SYSTEMS IN EUS-RFA

The effectiveness of EUS-RFA in treating pancreatic cancer can be largely attributed to significant technological advancements in the procedure[9]. Traditional RFA techniques have evolved through the incorporation of both monopolar and bipolar radiofrequency systems. Monopolar systems deliver energy from a single electrode to a grounding pad, whereas bipolar systems use two electrodes to generate energy, offering improved control over tissue ablation. These technologies provide more localized energy delivery, thereby minimizing the risk of damage to surrounding healthy tissues. One notable example is the study by Wang et al[10], which evaluated the feasibility and safety of a multiple-round, low-power monopolar EUS-RFA approach in 11 patients with unresectable pancreatic cancer. In this study, the RITA 1500X generator delivered 5-10 watts for 90 seconds, repeated in multiple sessions, with some patients undergoing a second session a week later and one patient receiving up to eight ablations. This low-energy, staged approach allowed for precise, stepwise necrosis of tumor tissue while avoiding thermal injury to adjacent structures. Importantly, the procedure was technically successful in all patients, with no major adverse events (AEs) reported. Post-treatment imaging revealed tumor size reduction in two patients and decreased serum CA19-9 levels in five others, suggesting early efficacy of this energy delivery protocol. These findings support the notion that carefully titrated energy dosing using monopolar systems can improve safety and potentially extend survival in patients with advanced pancreatic tumors. Furthermore, the application of multi-electrode systems and the development of larger diameter needles have contributed to more effective ablation of larger or more complex tumors[11]. Multi-electrode technology allows for simultaneous delivery of energy to multiple regions within the tumor, resulting in a more uniform ablation area and reducing procedure time[12]. This innovation is particularly valuable in treating larger pancreatic tumors, which traditionally posed a challenge for conventional RFA techniques. The use of larger needles with enhanced capability to reach deeper tissues allows for the treatment of tumors located in less accessible areas of the pancreas, further extending the applicability of EUS-RFA[13].

PROBE DESIGNS AND THERMAL MONITORING IN EUS-RFA

In recent years, novel probe designs, including flexible, steerable, and fine-gauge electrodes, have substantially improved the precision and adaptability of EUS-RFA, particularly for the treatment of pancreatic ductal adenocarcinoma (PDAC)[14]. These innovations have allowed clinicians to target tumors more accurately, especially those located deep within the pancreas or adjacent to critical structures such as the duodenum, portal vein, or mesenteric vessels[15]. Robles-Medranda et al[16] evaluated the feasibility and safety of EUS-RFA in 26 patients with unresectable PDAC, including both locally advanced (LA-PDAC) and metastatic cases (mPDAC). The procedure was performed using a 19-gauge needle electrode equipped with a 10-mm active tip, a probe specifically engineered to deliver focused energy over a controlled area, enabling precise tumor ablation. This needle design not only allows for deep tissue penetration, but also for careful navigation of the tortuous pancreatic anatomy, offering steering and angulation flexibility under real-time endoscopic ultrasound (EUS) guidance. In this study, technical success was achieved in all 26 patients, with no major AEs reported. Importantly, imaging follow-up at 6 months revealed clear hypodense necrotic zones, consistent with successful ablation, in 100% of surviving patients. The use of this advanced probe design was pivotal in enabling localized, confined ablation, while minimizing thermal injury to surrounding tissues. Tumor size significantly reduced (from 39.5 mm to 26 mm; P = 0.04), and performance status (PS) improved notably (P = 0.03). These results demonstrate how engineering enhancements in probe design directly translate into clinical efficacy and safety. While traditional rigid or thick probes posed risks of off-target thermal spread, newer fine-caliber, steerable electrodes with active tip control enable clinicians to deliver energy precisely within irregular tumor boundaries. Of note, divergent patient selection criteria may impact the comparability and generalizability of outcomes across studies. For example, the Robles-Medranda et al’s study[16] included both locally advanced and metastatic PDAC cases, while Wang et al[10] focused solely on unresectable, non-metastatic patients. These differences may partially explain discrepancies in observed survival benefits or complication rates. Additionally, thermal monitoring using hyperechoic changes and Doppler visualization during the procedure further supports precise energy modulation. Effective thermal ablation during EUS-RFA typically requires temperatures between 60-100 °C, with 70 °C being optimal for tumor tissue destruction without excessive damage to surrounding structures. Temperatures above 100 °C can lead to over-ablation, causing damage to adjacent healthy tissues, potentially resulting in complications such as vascular injury, gastrointestinal perforation, and excessive fibrosis, which can increase the risk of AEs. These developments underscore the critical role of integrated device design and thermal feedback in optimizing outcomes of EUS-RFA, particularly in complex clinical scenarios like unresectable or borderline resectable pancreatic cancer[17]. As such, probe evolution and real-time thermal management are not merely technical enhancements, but essential enablers of EUS-RFA’s broader adoption in oncology[18]. Recent innovations have also included the development of advanced thermal monitoring techniques[19]. These methods allow for continuous tracking of tissue temperature during the procedure, ensuring that the targeted tissue reaches the optimal temperature for effective ablation[20]. Temperature control is essential to prevent over- or under-ablation, as excessively high temperatures can damage surrounding structures, while inadequate temperatures may result in suboptimal tumor destruction. The combination of thermal monitoring with real-time imaging has enhanced the precision of EUS-RFA, making it a more reliable and reproducible treatment option.

REAL-TIME IMAGING IN EUS-RFA

In addition to the significant advancements in energy delivery systems and probe designs, the integration of real-time imaging technologies has played a pivotal role in enhancing the precision, safety, and effectiveness of EUS-RFA in treating pancreatic cancer[21]. The ability to monitor the extent of tissue ablation in real time, coupled with advanced imaging techniques, allows clinicians to achieve more controlled and effective tumor destruction[22]. The use of EUS as a guiding tool allows for unparalleled visualization of pancreatic tumors and surrounding anatomical structures[23]. This imaging modality is indispensable because the pancreas is located deep within the abdomen and is in close proximity to critical organs and vessels, such as the stomach, spleen, and large blood vessels like the superior mesenteric artery and the portal vein[24]. The deep location of pancreatic tumors, combined with their often irregular shape and intimate relationship with these vital structures, makes traditional imaging techniques like computed tomography (CT) and magnetic resonance imaging (MRI) less reliable for precise tumor targeting during ablation. EUS, with its high-resolution imaging capabilities, enables clinicians to obtain detailed, real-time views of the tumor, along with its relationship to adjacent organs and blood vessels[25]. This high degree of spatial resolution is particularly critical when treating pancreatic cancer, as it provides clinicians with the necessary information to accurately identify the tumor’s size, location, and exact boundaries. By integrating EUS with RFA technology, clinicians can guide the needle placement with greater precision, ensuring that the ablation energy is delivered directly to the tumor while sparing nearby healthy tissue and structures. Such advancements are crucial given the challenges posed by the complex anatomy of the pancreas, which is situated near vital structures such as blood vessels and the duodenum[26]. With the improved precision and reduced risk of complications, EUS-RFA has become an increasingly viable option in the management of pancreatic cancer, particularly for tumors that are not amenable to surgical resection[27]. The clinical value of this approach was well-demonstrated in a prospective cohort study by Thosani et al[28], involving 10 patients with locally advanced or metastatic PDAC. Patients underwent 1-4 EUS-RFA sessions under real-time EUS guidance, enabling accurate probe positioning and avoiding vascular or ductal injury. Importantly, no major AEs were observed, and the median overall survival (OS) reached 20.5 months, significantly surpassing historical controls. Follow-up imaging confirmed tumor regression in six patients, including three with more than 50% volume reduction. One patient even became eligible for surgical resection following RFA-induced tumor downsizing. One of the major advantages of using real-time imaging in EUS-RFA is its ability to monitor the ablation zone during the procedure. Moreover, the use of real-time EUS imaging allows clinicians to dynamically assess the effects of the ablation during the procedure. The ability to visualize the tumor and surrounding tissues in real time also facilitates the safe management of potential complications. Additionally, EUS enables precise identification of the tumor's boundaries, ensuring that the energy is delivered in a controlled manner, reducing the chance of thermal injury to adjacent structures like the duodenum, which is often in close proximity to pancreatic tumors[29].

In real-time imaging during EUS-RFA, high-resolution ultrasound and Doppler imaging are used to monitor the boundaries of thermal ablation. Hyperechoic changes in tissue are indicative of coagulation and necrosis, with the ablation zone appearing as a well-defined area of necrotic tissue. These changes mark the boundaries of the thermal ablation. To assess therapeutic efficacy, post-ablation imaging reveals tumor size reduction, necrotic tissue formation, and decreased vascularity, which signify successful treatment. Additionally, a reduction in serum tumor markers, such as CA19-9, may further confirm the effectiveness of the procedure. EUS has been shown to help guide the procedure in real-time when performing ablations on tumors located in complex or challenging areas, such as those in the head of the pancreas or near the mesenteric vessels.

COMBINATION THERAPY WITH SYSTEMIC TREATMENT

The combination of EUS-RFA with systemic therapies has shown promising results, particularly in improving both OS and progression-free survival (PFS)[30]. While chemotherapy remains the cornerstone of treatment for advanced pancreatic cancer, the addition of EUS-RFA to chemotherapy regimens appears to enhance therapeutic outcomes. Studies suggest that this combination leads to more significant tumor shrinkage, improved symptom control, and potentially prolonged survival when compared to chemotherapy alone. Recent prospective and matched cohort studies have provided compelling evidence supporting this synergistic approach (Table 2). In a matched analysis comparing patients with unresectable PDAC (UPDAC) ≤ 4 cm in diameter who underwent EUS-RFA with controls receiving chemotherapy alone, the median survival was significantly longer in the EUS-RFA group (13.4 months vs 7.7 months; hazard ratio 0.50, P = 0.03)[31]. Notably, the one-year survival probability reached 58% in the EUS-RFA group, compared to only 22% among controls, with only mild AEs observed in 10% of procedures. This suggests that EUS-RFA may offer meaningful survival benefits in selected patients with small-sized UPDAC, with minimal toxicity (TCTR20180706001). Another prospective observational study evaluating EUS-RFA combined with gemcitabine-based chemotherapy in 22 patients with unresectable pancreatic cancer (including 14 with locally advanced disease and 8 with metastasis) reported a median OS of 24.03 months and a median PFS of 16.37 months[32]. The procedure was technically successful in all patients, with a low early complication rate of 3.74%. These favorable outcomes indicate that EUS-RFA is not only safe and feasible but may also significantly extend survival when integrated into systemic treatment strategies. In addition, an open-label pilot study (ERAP) directly compared EUS-RFA plus chemotherapy with chemotherapy alone in patients with unresectable PDAC[33]. Among those who completed the study, the EUS-RFA group (n = 10) achieved 100% tumor necrosis vs 50% in the chemotherapy-only group (n = 12) (P = 0.014). Notably, the tumor size significantly increased in the control group after treatment (P = 0.017), whereas it remained stable in the EUS-RFA group. Moreover, patients in the EUS-RFA group were able to significantly reduce their daily narcotic pain medication by 26.5 mg morphine equivalents (P = 0.022), while no such reduction was seen in the control group. The procedure was well-tolerated, with only one mild AE reported among 30 EUS-RFA sessions. These findings suggest that EUS-RFA may contribute not only to local tumor control, but also to improved quality of life through enhanced symptom relief. The synergistic effect of this combination may be attributed to the complementary nature of the therapies. EUS-RFA induces localized tumor necrosis, potentially releasing tumor antigens and altering the tumor microenvironment, while systemic chemotherapy targets residual microscopic disease. This multimodal approach may help overcome limitations of monotherapy, such as chemo-resistance or insufficient local control, thereby offering a more comprehensive strategy for disease management[34]. For patients who are ineligible for surgery, combining EUS-RFA with chemotherapy presents a valuable therapeutic option that may delay progression and improve quality of life.

Table 2 Representative endoscopic ultrasound-guided radiofrequency ablation combined with systemic therapy in pancreatic cancer.

Design & sample	Key outcomes	Combination benefit	Ref.
Prospective cohort: 22 PDAC patients, 19 received systemic gemcitabine-based chemotherapy	OS = approximately 24 months; only 1 patient had peritonitis as AE	Patients had significantly prolonged survival with EUS-RFA + chemotherapy	Oh et al[32], 2022
Matched analysis: 11 EUS-RFA + chemo patients vs 35 chemo-only controls	Median OS 14 months vs 6.1 months; HR = 0.38, P = 0.016; PFS improved at 6 months and 12 months	EUS-RFA doubled survival and progression-free intervals compared to chemo alone	Kongkam et al[31], 2025
Prospective case series: 10 PDAC patients (locally advanced/metastatic) + concurrent standard chemotherapy	Median OS = 20.5 months (95%CI: 9.93-42.2); tumor regression in 6/10 patients; no major AE; long-term survivors (61 months and 81 months)	EUS-RFA was safe, improved outcomes beyond SEER/clinical trial median survival; 1 case converted to resection	Thosani et al[28], 2022
Open-label pilot observational study: 14 EUS-RFA + chemo vs 14 chemo-only in unresectable PDAC	100% vs 50% tumor necrosis (P = 0.014); pain meds significantly reduced in RFA group; tumor grew in chemo-only group (P = 0.017)	RFA group had significantly higher necrosis rate and reduced narcotic usage; minimal AE (1/30 procedures, 3.3%)	ERAP study[33], 2023

PDAC: Pancreatic ductal adenocarcinoma; RFA: Radiofrequency ablation; OS: Overall survival; EUS-RFA: Endoscopic ultrasound-guided radiofrequency ablation; AE: Adverse event; HR: Hazard ratio.

IMMUNOMODULATORY EFFECTS AND POTENTIAL FOR IMMUNOTHERAPY

In addition to its direct cytotoxic effects on tumor cells, RFA has been shown to stimulate the immune system in ways that enhance its potential as part of a broader treatment strategy (Figure 1). RFA induces an immune response by releasing tumor-associated antigens from the ablated tissue, which can then be recognized by the body’s immune system[35]. This release of tumor antigens serves as a form of "in situ" vaccination, potentially priming the immune system to recognize and attack residual cancer cells[36].

Figure 1 Radiofrequency ablation-mediated immune modulation. RFA: Radiofrequency ablation.

Moreover, RFA can alter the tumor microenvironment, making it more conducive to immune cell infiltration and activation[37]. Tumors often create a suppressive microenvironment that inhibits the action of immune cells. However, RFA can reverse some of these immunosuppressive factors, thus promoting a more favorable environment for immune cells to function effectively[38]. These immunomodulatory effects open the door to combining EUS-RFA with immunotherapy, such as immune checkpoint inhibitors, to enhance treatment efficacy. By combining these two strategies, it may be possible to amplify the immune response against pancreatic tumors, potentially improving outcomes in patients with advanced disease[39].

AES AND SAFETY PROFILE OF EUS-RFA

The safety of EUS-RFA is a critical consideration, especially given its emerging role in the treatment of pancreatic cancer. While clinical studies to date have generally reported a low incidence of severe AEs, a detailed examination of these events is essential for robust clinical risk stratification and mitigation[40]. AEs associated with EUS-RFA are classified according to the Common Terminology Criteria for Adverse Events. To minimize the occurrence of AEs, several strategies should be employed. Advanced imaging modalities such as multi-modal EUS, MRI, and CT scans help assess tumor proximity to vital structures, including blood vessels and the duodenum, reducing the risk of severe complications[41]. Real-time imaging during the procedure allows for precise needle placement, ensuring that energy is delivered safely and effectively to the tumor while minimizing collateral damage to surrounding tissues.

SIDE EFFECTS, COMPLICATIONS, CONTRAINDICATIONS, AND INDICATIONS FOR EUS-RFA

The clinical application of EUS-RFA requires careful consideration of potential side effects, complications, and patient suitability. Common mild side effects include abdominal pain, fever, and nausea, which generally resolve with conservative management[32]. Severe complications, though rare, may include pancreatitis, gastrointestinal bleeding, duodenal injury, and gastrointestinal perforation, which require prompt intervention[42]. Relative contraindications include tumors near major blood vessels or the duodenum, as well as patients with poor PS, severe coagulopathy, or active infection, as these conditions increase the risk of complications. EUS-RFA is most beneficial for patients with locally advanced or unresectable pancreatic cancer, especially when surgical resection is not feasible, or conventional therapies have been ineffective[43]. It is particularly useful for tumors that are difficult to access surgically or located near critical structures and is often combined with chemotherapy or immunotherapy to improve therapeutic outcomes.

CHALLENGES AND FUTURE DIRECTIONS

Despite the encouraging clinical data and technological advancements, the widespread adoption of EUS-RFA is hindered by several key limitations. One of the most significant barriers is the lack of large-scale randomized controlled trials (RCTs) that provide robust evidence on the long-term efficacy and safety of EUS-RFA. Most of the available studies are small, retrospective, or single-center trials, which limit the generalizability of the findings. Without large, multicenter RCTs, it remains difficult to establish clear clinical guidelines or definitive conclusions on the role of EUS-RFA in the treatment of pancreatic cancer. Another limitation is the absence of standardized treatment protocols. While the procedure has been proven effective in many centers, variations in technique, patient selection, and post-procedure care can impact the consistency of results. Standardized protocols that address these variables are needed to ensure that EUS-RFA is performed optimally and its benefits maximized across different healthcare settings.

Future research should focus on addressing these gaps by conducting large-scale, multicenter RCTs to establish the long-term benefits and safety of EUS-RFA. In addition to the traditional recommendations for RCTs and standardized protocols, future research in EUS-RFA for pancreatic cancer should delve into more advanced and innovative avenues. One promising direction is the integration of radiomics and predictive biomarkers to optimize patient stratification. The timing of immunotherapy in relation to EUS-RFA is another critical area, and a holistic assessment of tumor characteristics, encompassing tumor dimensions, anatomical localization, and proximity to critical vascular structures, is essential. Additionally, further studies are needed to define the optimal patient population for this treatment, including identifying biomarkers that predict which patients are most likely to benefit. Research into the optimal combination of EUS-RFA with other therapies, particularly immunotherapies, is also crucial. Understanding how to integrate EUS-RFA into a multimodal treatment regimen, including its use as a neoadjuvant therapy in resectable pancreatic cancer, could further enhance its role in the management of the disease. Moreover, as the technology behind EUS-RFA continues to evolve, it is important to explore newer probe designs, energy delivery systems, and imaging techniques to further refine the procedure. Ongoing technological innovations, such as real-time monitoring of the ablation zone, could improve the precision and effectiveness of the procedure, making it more accessible and beneficial to a wider range of patients.

CONCLUSION

EUS-RFA has emerged as a promising minimally invasive treatment for pancreatic cancer, offering high technical success rates, an excellent safety profile, and the potential for improved clinical outcomes. The combination of EUS-RFA with systemic therapies, coupled with its potential immunomodulatory effects, suggests that it may play a vital role in future multimodal therapeutic strategies. However, to realize its full potential, more research is needed to establish definitive evidence through large-scale trials, standardize treatment protocols, and explore its integration with immunotherapy and other therapeutic modalities. As we move forward, the continued advancement of EUS-RFA technology and the refinement of treatment strategies will be critical in improving outcomes for patients with pancreatic cancer.