Systematic review of novel ablative methods in locally advanced pancreatic cancer

Table 3 Studies of radiofrequency ablation in pancreatic ductal adenocarcinoma

Study	Patients	n	Route of administration	Device	RFA temp (°C)	RFA duration (min)	Outcome	Complications
Matsui et al[12]	Unresectable PDAC	20 LA:9 M:11	At laparotomy 4 RFA probes were inserted into the tumour 2 cm apart	A 13.56-MHz RFA pulse was produced by the heating apparatus	50	15	Survival: 3 mo	Mortality: 10% (septic shock and gastrointestinal bleeding)
Hadjicostas et al[14]	Locally advanced and unresectable PDAC	4	Intraoperative (followed by palliative bypass surgery)	Cool-tip™ RFAblation system	NR	2-8	All patients were alive one year post-RFA	No complications encountered
Wu et al[10]	Unresectable PDAC	16 LA:11 M:5	Intraoperative	Cool-tip™ RFAblation system	30-90	12 at 30 °C then 1 at 90 °C	Pain relief: back pain improved (6/12)	Mortality: 25% (4/16) Pancreatic fistula: 18.8% (3/16)
Spiliotis et al[11]	Stage III and IV PDAC receiving palliative therapy	12 LA:8 M:4	Intraoperative (followed by palliative bypass surgery)	Cool-tip™ RFAblation system	90	5-7	Mean survival: 33 mo	Morbidity: 16% (biliary leak) Mortality: 0%
Girelli et al[7]	Unresectable locally advanced PDAC	50	Intraoperative (followed by palliative bypass surgery)	Cool-tip™ RFAblation system	105 (25 pts) 90 (25 pts)	Not reported	Not reported	Morbidity 40% in the first 25 patients. Probe temperature decreased from 105°C to 90 °C Morbidity 8% in second cohort of 25 patients. 30-d mortality: 2%
Girelli et al[50]	Unresectable locally advanced PDAC	100	Intraoperative (followed by palliative bypass surgery)	Cool-tip™ RFAblation system	90	5-10	Median overall survival: 20 mo	Morbidity: 15%. Mortality: 3%
Giardino et al[51]	Unresectable PDAC. 47 RFA alone. 60 had RFA + radiochemotherapy (RCT) and/or intra-arterial systemic chemotherapy (IASC)	107	Intraoperative (followed by palliative bypass surgery)	Cool-tip™ RFAblation system	90	5-10	Median overall survival: 14.7 mo in RFA alone but 25.6 mo in those receiving RFA + RCT and/or IADC (P = 0.004)	Mortality: 1.8% (liver failure and duodenal perforation) Morbidity: 28%
Arcidiacono et al[19]	Locally advanced PDAC	22	EUS-guided	Cryotherm probe; bipolar RFA + cryogenic cooling	NR	2-15	Feasible in 16/22 (72.8%)	Pain (3/22)
Steel et al[41]	Unresectable malignant bile duct obstruction (16/22 due to PDAC)	22	RFA + SEMS placement at ERCP	Habib EndoHPB wire guided catheter	NR	Sequential 2 min treatments - median 2 (range 1-4)	Median survival: 6 mo Successful biliary decompression (21/22)	Minor bleeding (1/22) Asymptomatic biochemical pancreatitis (1/22), percutaneous gallbladder drainage (2/22). At 90-d, 2/22 had died, one with a patent SEMS
Figueroa-Barojas et al[42]	Unresectable malignant bile duct obstruction (7/20 due to PDAC)	20	RFA + SEMS placement at ERCP	Habib EndoHPB wire guided catheter	NR	Sequential 2 min treatments	SEMS occlusion at 90 d (3/22) Bile duct diameter increased by 3.5mm post RFA (P = 0.0001)	Abdominal pain (5/20), mild post-ERCP pancreatitis and cholecystitis (1/20)
Pai et al[20]	Locally advanced PDAC	7	EUS-guided	Habib EUS-RFA catheter	NR	Sequential 90s treatments - median 3 (range 2-4)	2/7 tumours decreased in size	Mild pancreatitis: (1/7)

PDAC: Pancreatic ductal adenocarcinoma; LA: Locally advanced PDAC; M: Metastatic PDAC; SEMS: Self-expanding metal stent; RFA: Radiofrequency ablation; EUS: Endoscopic ultrasound; ERCP: Endoscopic retrograde cholangiopancreatography.