Combined modality treatment for patients with locally advanced pancreatic adenocarcinoma

Cantore, Maurizio; Girelli, R.; Mambrini, Andrea; Frigerio, Isabella; Boz, G.; Salvia, Roberto; Giardino, Alessandro; Orlandi, M.; Amato, Alessandra; Bassi, Claudio

doi:10.1002/bjs.8789

Cited by 63 publications

(57 citation statements)

References 26 publications

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“…We should not forget that RFA is a cytoreductive treatment which does not aim to eradicate the tumor: what is left in site after RFA can be specifically targeted by following radiotherapy and systemic or intraarterial chemotherapy. These results seem in contrast to what has been recently published by Cantore and us [16] where a combined multi-treatment followed by RFA could significantly prolong survival: as Cantore himself states in his paper the extraordinary survival rate of 25.6 months may reflect the inherent selection bias that is inevitable in some patients who receive second-line RFA, who must have benefited from an earlier treatment in order to receive RFA later. The rate of early progression was the same with or without chemotherapy (12.3 and 16 %, n.s.)…”

Section: Discussioncontrasting

confidence: 85%

Short term chemotherapy followed by radiofrequency ablation in stage III pancreatic cancer: results from a single center

Frigerio

Girelli

Giardino

et al. 2013

J Hepato Biliary Pancreat

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Background Neo-adjuvant chemotherapy (CHT) has gained increasing importance in resectable and borderline resectable pancreatic cancer leading to a better performing surgery when we look at negative resection margins and selection of patients with less aggressive disease. We apply this principle to patients with Stage III (LAC) pancreatic cancer undergoing RFA and try to select patients who may benefit from a local treatment. Methods All patients affected by LAC were treated with RFA for a stable disease after a short CHT. Postoperative morbidity and mortality were evaluated together with overall survival (OS) and disease specific survival (DSS). Results We consecutively treated 57 patients affected by LAC. Median duration of CHT before RFA was 5 months. The postoperative mortality rate was zero. Overall morbidity was 14 % with RFA-related morbidity of 3.5 %. The OS and DSS were 19 months and when compared to a similar population who received RFA as up front treatment, there was no difference. Conclusions Our results do not support the adoption of a short CHT as a way to identify patients to treat with RFA with the most benefit. Based on this and by knowing the role of immune modulation after RFA and its specific involvement in pancreatic carcinoma, we can propose RFA as upfront treatment.

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Section: Discussioncontrasting

confidence: 85%

Short term chemotherapy followed by radiofrequency ablation in stage III pancreatic cancer: results from a single center

Frigerio

Girelli

Giardino

et al. 2013

J Hepato Biliary Pancreat

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“…Tumors were located in the pancreas head (3), body (3), and uncinate process (2). One patient with pancreatic head cancer underwent EUS-RFA with a previously placed plastic biliary stent.…”

Section: Resultsmentioning

confidence: 99%

“…Different chemo and/ or radiotherapies have had poor results, with the five-year survival rate at around 5-7% [1]. In this setting, combining multimodality therapies might improve the treatment outcome [2]. Radiofrequency ablation (RFA) produces a thermalinduced coagulative necrosis of the tumor [3].…”

Section: Introductionmentioning

confidence: 99%

EUS-guided Radiofrequency Ablation (EUS-RFA) of Solid Pancreatic Neoplasm Using an 18-gauge Needle Electrode: Feasibility, Safety, and Technical Success

Crinò¹,

D’Onofrio

Bernardoni³

et al. 2018

JGLD

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Background & Aims: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a promising technique for the treatment of pancreatic neoplasm. We evaluated the feasibility, safety, and technical success of pancreatic EUS-RFA performed in a single center.Methods: 9 consecutive patients (8 with pancreatic adenocarcinoma and 1 with renal cancer metastasis) were referred for EUS-RFA between November 2016 and July 2017. EUS-RFA was performed using 18-gauge internally cooled electrode with a 5 or 10 mm exposed tip. Feasibility, technical success or early and late adverse events were assessed.Results: One patient was excluded because of a large necrotic portion. EUS-RFA was feasible in all the other 8 (100%) cases. An ablated area inside the tumor was achieved in all treated patients. No early or late major adverse event was observed after a mean follow-up of 6 months. Three patients experienced mild postprocedural abdominal pain.Conclusions: EUS-RFA seems a feasible, safe, and effective procedure for pancreatic neoplasms. Its role in the treatment and management of pancreatic masses must be further investigated.

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“…Complications are related mainly to thermal injuries to the nearest organs, such as the biliary tract, duodenum, portal vein and transverse colon, and the prevalence of such injuries is ≈24%. Promising results have come from the association of RFA with radiochemotherapy or systemic chemotherapy: median survival is 25.6 months with an intra-abdominal morbidity rate of 26.2% [23].…”

Section: Ablative Methodsmentioning

confidence: 99%

Pancreatic Adenocarcinoma

Filauro

Rollandi

Ruggieri

et al. 2013

What’s New in Surgical Oncology

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Combined modality treatment for patients with locally advanced pancreatic adenocarcinoma

Abstract: RFA after alternative primary treatment was associated with prolonged survival. This was further extended by use of a triple-approach strategy in selected patients. Further evaluation of this approach seems warranted.

Cited by 63 publications

References 26 publications

Short term chemotherapy followed by radiofrequency ablation in stage III pancreatic cancer: results from a single center

Short term chemotherapy followed by radiofrequency ablation in stage III pancreatic cancer: results from a single center

EUS-guided Radiofrequency Ablation (EUS-RFA) of Solid Pancreatic Neoplasm Using an 18-gauge Needle Electrode: Feasibility, Safety, and Technical Success

Pancreatic Adenocarcinoma

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