One-year survival rate of unresectable pancreatic cancer size 4 cm or smaller treated with or without EUS-radiofrequency ablation.

BACKGROUND AND AIMS: The prognosis for unresectable pancreatic ductal adenocarcinoma (UPDAC) remains poor with current treatments. This study evaluates the survival benefits of EUS-guided radiofrequency ablation (RFA) in UPDAC ≤4 cm.

METHODS

A prospective series of patients who underwent EUS-RFA (January 2017 to September 2022) was compared with controls. Propensity score matching was applied using tumor size, staging, age-adjusted Charlson Comorbidity Index, and chemotherapy regimen. Inverse probability weighting was used to estimate treatment effects on survival, local progression, and response rates.

RESULTS

Among 47 patients (12 EUS-RFA, 35 controls), median survival was 13.4 months in the EUS-RFA group versus 7.7 months for controls (hazard ratio, 0.50; P = .03). The survival probability at 12 months was 58% in the EUS-RFA group versus 22% for controls (P = .04). Adverse events were mild abdominal pain in 10% of RFA operations.

CONCLUSIONS

EUS-RFA as an adjunct for UPDAC ≤4 cm may improve survival with minimal side effects. (Trial registration: The study was a secondary exploratory analysis of a clinical trial registered at Thai Clinical Trials Registry (https://www.thaiclinicaltrials.org/show/TCTR20180706001) with clinical trial number 20180706001.).