Local Ablative Strategies for Ductal Pancreatic Cancer (Radiofrequency Ablation, Irreversible Electroporation): A Review

Salvatore Paiella, Roberto Salvia, Marco Ramera, Roberto Girelli, Isabella Frigerio, Alessandro Giardino, Valentina Allegrini, Claudio Bassi, Salvatore Paiella, Roberto Salvia, Marco Ramera, Roberto Girelli, Isabella Frigerio, Alessandro Giardino, Valentina Allegrini, Claudio Bassi

Abstract

Pancreatic ductal adenocarcinoma (PDAC) has still a dismal prognosis. Locally advanced pancreatic cancer (LAPC) accounts for the 40% of the new diagnoses. Current treatment options are based on chemo- and radiotherapy regimens. Local ablative techniques seem to be the future therapeutic option for stage-III patients with PDAC. Radiofrequency Ablation (RFA) and Irreversible Electroporation (IRE) are actually the most emerging local ablative techniques used on LAPC. Initial clinical studies on the use of these techniques have already demonstrated encouraging results in terms of safety and feasibility. Unfortunately, few studies on their efficacy are currently available. Even though some reports on the overall survival are encouraging, randomized studies are still required to corroborate these findings. This study provides an up-to-date overview and a thematic summary of the current available evidence on the application of RFA and IRE on PDAC, together with a comparison of the two procedures.

Figures

Figure 1
Figure 1
US-guided intraoperative application of RFA tip.
Figure 2
Figure 2
Example of a computerized model of the application of a 4-needle IRE technique. The yellow oval represents the tumor. Crossing blue beams represent the energy developed between each couple of probes.
Figure 3
Figure 3
(a) Preoperative CT-scan of a locally advanced pancreatic cancer. (b) Post-RFA perfusion CT-scan, showing a postablative area of decreased perfusion within the head of the pancreas. Copyright Chirurgia del Pancreas Verona.
Figure 4
Figure 4
(a) The tip for RFA is placed inside the tumor under US-guidance. (b) During RFA, the lesion becomes immediately hyperechoic.

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