Radiofrequency ablation of pancreatic ductal adenocarcinoma: The past, the present and the future

Table 1 Case series on radiofrequency ablation of pancreatic ductal adenocarcinoma-themokinetic principles

Ref.	n	Age (yr)	Tumour size (cm)	Thermokinetics
Matsui et al[24]	20	59	5.3	15 min at 50 °C in 2 × 2 × 2 cc field
Date et al[25]	1	58	3	RITA probe, 90 °C for 10 min each
Hadjicostas et al[26]	4	70	8.5 (3-12)	Cooltip© RFA for shorter duration of 2-8 min with 17-gauge electrode
Varshney et al[27]	3	58	6.5	4200 W of energy was delivered using a saline perfused needle with the aim of producing a 3 cm diameter necrosis
Wu et al[28]	16	67	51	Cooltip© RFA probe with up to 200 W energy, 12 min and tip temperature < 30 °C. A 5 mm safe distance between probe and major vessel
Spiliotis et al[20]	12	67	3.5	Cooltip© 17-gauge RFA electrode which achieved 80-90 °C. Cooltip© at < 10 min each
Casadei et al[29]	3	66	4.7	Cooltip© ablation at 90 °C for 5 min each
Girelli et al[11]	50	65	4	RITA system was used. Initial temperature of 105 °C (first 25 patients) was reduced to 90 °C after interim review
Zou3 et al[30]	32	68	4-122	17 gauge electrode at 100-150 W energy with tip temperature of 90-100 °C for 12 min each After RFA, 125Iodine seed was implanted
Ikuta et al[31]	1	60	4	Cooltip© 17-gauge RFA electrode for 3-4 min each and a temperature of 99 °C

¹82% tumors were > 5 cm;

²Mean/median size not mentioned;

³Simultaneous

¹²⁵I seed implantation. RFA: Radiofrequency ablation.

Table 2 Case series on radiofrequency ablation of pancreatic ductal adenocarcinoma-outcomes and comments

Ref.	Survival	Morbidity and mortality	Comments
Matsui et al[24]	3 mo (median)	Morbidity (10%)-septic shock and gastrointestinal bleeding Mortality (5%)-patient with septic shock	All patients had a laparotomy
Date et al[25]	3 mo (overall)	Patient developed polyuria. No major complication	Single patient
Hadjicostas et al[26]	7 mo (median)	No major complications occurred	Sandostatin was administered prophylactically. Palliative bypass procedures were performed. One patient had significant pain relief
Varshney et al[27]	7 mo (mean)	Self-limiting complications occurred in two patients	One patient had percutaneous CT guided RFA. All patients had endobiliary stenting All patients received 7 d of antibiotics
Later this group has updated their results in 10 patients with 10% morbidity and no mortality. Eight patients received post RFA chemotherapy. One patient developed a 2 cm pseudocyst. Overall survival range was 9-36 mo[32]
Wu et al[28]	Not reported	Pancreatic fistula 18.8% (3/16). Overall morbidity 43%. Mortality 25% Massive and mortal gastrointestinal bleeding occurred in 3 patients	Initially performed only for body and tail lesions. Later expanded for head of pancreas lesions, but had 50% mortality in this group 50% patients had relief of back pain 5 patients had liver metastases 5 mm distance to portal vein may not be safe
Spiliotis et al[20]	33 mo (mean)	Overall morbidity 25% and nil mortality	Mean survival without RFA was 13 mo RFA in parallel to palliative therapy provided survival benefit for patients with unresectable pancreatic cancer
Casadei et al[29]	4 mo (mean)	3 patients developed ascites 1 patient developed biliary fistula	Prospective study. Included 3 patients Complete necrosis achieved in all patients All patients had a laparotomy and double bypass. Study was stopped at interim analysis
Girelli et al[11]	Not reported	Abdominal complications occurred in 24%. 30 d mortality 2%. Three patients with surgery related complicated required reoperation	Prospective study RFA was the only treatment in 19 patients All patients received antibiotics, octreotide and gabexate mesilate. Reduction of RFA temperature from 105 °C to 900 °C resulted in significant reduction in complications
Later this group has updated their experience of 107 patients (Cantore et al[21]). They performed a group wise comparison between upfront RFA vs RFA following primary therapy and concluded that RFA following primary treatment improves survival (14.7 mo vs 25.6 mo)
Zou1 et al[30]	17.6 mo (mean)	Three patients experienced complications, but no mortality	Somatostatin analogues were used post-operatively The overall 12 mo survival was 65.6%
Ikuta et al[31]	Alive at 18 mo	No complications	Laparotomy with bypass procedure followed by chemoradiotherapy to induce pancreatic fibrosis. This was followed by second laparotomy and RFA

¹Simultaneous ¹²⁵I seed implantation. CT: Computerized tomography; RFA: Radiofrequency ablation.