Post written by Curtis J. Wray, MD, MS, from the Department of Surgery, Section of Surgical Oncology, and Nirav Thosani, MD, from the Department of Surgery, Section of Interventional Gastroenterology, University of Texas Health Science Center at Houston, Houston, Texas, USA.

This manuscript details our initial institutional experience using EUS-guided radiofrequency ablation (EUS-RFA) combined with systemic chemotherapy for treatment of resectable pancreatic ductal adenocarcinoma (PDAC). Repeated EUS-RFA of the pancreatic lesion was incorporated into the neoadjuvant treatment protocol prior to surgical resection.

Five-year survival data for PDAC have remained largely unchanged over the past decade. Introducing a potential new modality for treatment of resectable pancreatic cancer may increase preoperative treatment response and improve survival. 

These results suggest the EUS-RFA treatment is safe and resulted in downsizing of the PDAC tumors prior to surgery. The pancreatic resection was technically feasible, as fibrosis or scar tissue after EUS-RFA appeared minimal in this small cohort.

Additional studies are needed to examine the impact of EUS-RFA on the tumor microenvironment. This initial experience has facilitated design of our current PANcreatic CAncer RaDiofrequency AbLation-1 trial (PANCARDINAL-1; clinicaltrials.gov: NCT04990609). Further clinical trials are necessary to determine treatment effect of EUS-RFA as a therapy for PDAC.

Left, Trichrome staining showing the impact of EUS-guided radiofrequency ablation (RFA) in a patient with pancreatic ductal adenocarcinoma who received multiple RFA ablation sessions. The resected tumor presented a residual tumor foci with stromal cells (i) and a necrotic area with limited stromal cells near the ablated region (ii). Right, Images were amplified ×8.

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