Original Article  /  Pancreas

A prospective study on radiofrequency ablation locally advanced pancreatic cancer Riccardo Casadei, Claudio Ricci, Raffaele Pezzilli, Carla Serra, Lucia Calculli, Antonio Maria Morselli-Labate, Donatella Santini and Francesco Minni Bologna, Italy

BACKGROUND:  Radiofrequency ablation (RFA) has been suggested as a new treatment option for patients with locally advanced cancer. This study aimed to prospectively evaluate the efficacy and safety of intraoperative RFA in patients with unresectable, locally advanced, non-metastatic carcinoma of the pancreatic head. METHODS: RFA was the first step of the surgical procedure and was carried out on the mobilized pancreatic head followed by biliary by-pass and gastrojejunal-anastomosis. Intra- and post-operative morbidity and mortality, performance status, pain control, quality of life, and survival at 24 months were evaluated. RESULTS: Seven patients (3 men and 4 women; median age 66 years, range 47-80 years) were studied and 4 were eligible for treatment. The RFA procedure was carried out in 3 of the 4 patients; in one patient it was not carried out because of the upstaging of the neoplasm. In all 3 patients RFA achieved complete necrosis of the lesion. A biliary fistula developed 7 days after the procedure in one patient; all 3 patients developed ascites 8.6 days (range 7-9 days) on average after RFA. All patients died respectively, at 3, 4, and 5 months after the treatment. CONCLUSIONS:  In our experience, RFA is a feasible procedure, but it presents a very high rate of postoperative complications. Moreover, pain control, life quality and survival rate are poor. The few data suggest no impact on survival. (Hepatobiliary Pancreat Dis Int 2010; 9: 306-311)

Author Affiliations: Department of Surgery (Casadei R, Ricci C and Minni F), Department of Internal Medicine and Gastroenterology (Pezzilli R, Serra C and Morselli-Labate AM), Department of Radiology (Calculli L), and Department of Pathology (Santini D), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy Corresponding Author: Raffaele Pezzilli, MD, Department of Internal Medicine and Gastroenterology, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti n.9 40138, Bologna, Italy (Tel: +3905163641488; Fax: +390516364148; Email: [email protected]) © 2010, Hepatobiliary Pancreat Dis Int. All rights reserved.

KEY WORDS: pancreatic neoplasms; radiofrequency ablation; survival; efficacy; safety

Introduction

A

denocarcinoma of the pancreas is one of the most aggressive human cancers.[1] Surgical resection is the only potentially curative treatment for pancreatic cancer, but at the time of diagnosis radical surgery is possible in only 5%-25% of patients, with a 5-year survival rate no more than 29% in high volume centers.[2] Forty percent of patients with pancreatic adenocarcinoma have unresectable locally advanced disease with massive encasement of the major vessels (the portal and superior mesenteric vein and/ or the superior mesenteric artery and/or the hepatic artery).[3] Vascular reconstruction in these patients can be carried out with acceptable morbidity and mortality without a significant survival benefit.[4] Chemotherapy generally confers symptomatic improvement in these patients, improves the quality of life, and prolongs survival. Chemoradiation appears to be not superior to chemotherapy.[5] The patients who have undergone surgery with the purpose of curative resection for periampullary malignancies, but have been found to have an unresectable tumor should undergo a surgical biliary bypass.[6-8] Gastrojejunostomy is better than stent placement for treatment or prevention of gastric outlet obstruction in patients with a longer survival (non-metastatic) who are found to have unresectable pancreatic head cancer at laparotomy.[9, 10] Radiofrequency ablation (RFA) is a new, local thermal therapy used for the palliative treatment of solid parenchymal tumors.[11-18] RFA appears to be an attractive option in patients with unresectable, locally advanced and non-metastatic pancreatic cancer.[19] However, only

306 • Hepatobiliary Pancreat Dis Int，Vol 9，No 3 • June 15，2010 • www.hbpdint.com

Radiofrequency ablation for pancreatic cancer

Table 1. Inclusion and exclusion criteria for eligibility for RFA Inclusion criteria ASA status