Sa1441 ENDOSCOPIC ULTRASOUND-GUIDED RADIOFREQUENCY ABLATION OF PANCREATIC METASTASES FROM RENAL CELL CANCER: FEASIBILITY AND SAFETY

Abstract

Renal cell carcinoma (RCC) is the most common renal cancer in adults, characterised by high 5-year survival rates (up to 95%) when tumour is limited to the kidney. Up to 50% of patients will develop widespread metastatic disease after nephrectomy with worsening of the 5-year survival rate to 10%-15%. Pancreas is an elective site for RCC metastases. Surgery is the first choice for the treatment of pancreatic metastases. For not-resectable pancreatic metastases therapeutical options are limited. Radiofrequency ablation (RFA) is a local ablative method that destroys the tumour by thermal coagulation. RFA has been successfully performed in the treatment of not-resectable solid tumours of liver, lung and prostate. Recent studies have shown that endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a feasible and safe technique for the treatment of primary pancreatic lesions. However, there are no data regarding its use in the treatment of pancreatic metastases from RCC. The aim of the present study is to evaluate the feasibility and safety of EUS-RFA in the treatment of pancreatic metastases from RCC. This is a single centre prospective study. Patients affected by pancreatic metastases from RCC with non-resectable lesions or not amenable to surgery were enrolled. Patients and tumour features were recorded. All patients underwent EUS-RFA with a monopolar, 19 G RFA needle (Endoscopic UltraSound guided Radio-frequency Ablation electrode; EUSRA) directly introduced in the endoscope’s operative channel, with a RF power of 30W. All patients underwent CT/MRI scan after 24 hours from the procedure. Feasibility was defined as the possibility of inserting the needle in the lesion and applying the radiofrequency. Safety was defined by collecting data of any complication occurred within 3 months of follow-up. From January to August 2019, three patients were enrolled (2 women; mean age 64 ±19 years). Overall, four lesions were treated (Mean size 26±17 mm). 3 out of 4 lesions were located in pancreatic head. The procedure resulted feasible in 100% of cases. No complications occurred after the treatment. The post-procedural imaging showed in all cases the presence of a necrotic area in the site of treatment. EUS-RFA seems to be a feasible and safe technique for the treatment of not surgical pancreatic metastases from RCC. Further studies are necessary to determine the efficacy of this treatment.