Advances in radiofrequency ablation 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.

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.