Abstract
Pancreatic cancer is one of the most aggressive malignancies of the digestive tract and carries a poor prognosis. The majority of patients have advanced disease at the time of diagnosis. Surgical resection offers the only curative treatment, but only a small proportion of patients can undergo surgical resection. Radiofrequency ablation (RFA) is a well-known modality in the management of solid organ tumors, however, its utility in the management of pancreatic cancer is under investigation. Since the past decade, there is increasing use of RFA as it provides a feasible palliation treatment in the management of unresectable pancreatic cancer. RFA causes tumor cytoreduction through multiple mechanisms such as coagulative necrosis, protein denaturation, and activation of anticancer immunity. The safety profile of RFA is controversial because of the high risk for complications, however, small prospective and retrospective studies have shown promising results in its applicability for palliative management of unresectable pancreatic malignancies. In this review, we discuss different approaches of RFA, their indications, technical accessibility, safety, and major complications in the management of unresectable pancreatic cancer.
Highlights
Pancreatic cancer is one of the most aggressive gastrointestinal malignancies and is the fourth leading cause of mortality in the United States despite advancement in both diagnostic and therapeutic interventions in the management of these patients
Only 15–20% of the patients with pancreatic cancer are eligible for surgical resection, as majority of them present with locally advanced stages or with distant metastasis when surgical resection is not possible [3]
We provided an overview of Radiofrequency ablation (RFA) and discussed various approaches of RFA therapies in the management of pancreatic cancer
Summary
Pancreatic cancer is one of the most aggressive gastrointestinal malignancies and is the fourth leading cause of mortality in the United States despite advancement in both diagnostic and therapeutic interventions in the management of these patients. Intraoperative RFA is indicated in unresectable, non-metastatic and locally advanced pancreatic tumor involving pancreatic head or uncinate process that results in either obstructive jaundice or gastric outlet obstruction It is performed in patients who are found to be inoperable during surgery or those who are not amenable to percutaneous imaging guided or endoscopic guided interventions for palliation [7, 23,24,25]. In a small study of 4 patients with locally advanced unresectable pancreatic cancer, no difference of survival was noted after intraoperative RFA, CA 19-9 tumor marker was decreased in all patients without adverse events at 12 months follow up [7]. In a small pilot study of eight patients with neuroendocrine unresectable pancreatic cancer, ultrasound guided percutaneous RFA was performed in seven patients and a high clinical success of procedure as tumor regression was noted in all patients on median follow up of 34 months without any mortality [31]. There is increasing use of endoscopic-guided RFA for unresectable pancreatic adenocarcinoma, resectable tumors in patients
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