Feasibility and safety of EUS-guided cryothermal ablation in patients with locally advanced pancreatic cancer

Paolo Giorgio Arcidiacono, Silvia Carrara, Michele Reni, Maria Chiara Petrone, Stefano Cappio, Gianpaolo Balzano, Cinzia Boemo, Stefano Cereda, Roberto Nicoletti, Markus Dominik Enderle, Alexander Neugebauer, Daniel Von Renteln, Axel Eickhoff, Pier Alberto Testoni

Research output: Contribution to journalArticlepeer-review

Abstract

Background: New therapies are needed for pancreatic cancer. Objective: To determine the feasibility and safety of a new endoscopic treatment. Secondary endpoints were to determine effects on tumor growth measured with CT scan and to find the overall survival. Design: A cohort study of patients with local progression of advanced pancreatic adenocarcinoma after neoadjuvant therapy. The cryotherm probe (CTP), a flexible bipolar device that combines radiofrequency with cryogenic cooling, was used under EUS guidance. Setting: San Raffaele Hospital, Milan, Italy; University Medical Center, Hamburg-Eppendorf, Germany. Patients: A total of 22 patients (male/female 11/11; mean age 61.9 years) were enrolled from September 2009 to May 2011. Intervention: Radiofrequency heating: 18 W; pressure for cooling: 650 psi (Pounds per Square Inch); application time: depending on tumor size. Main Outcome Measurements: Feasibility was evaluated during the procedure. A clinical and radiologic follow-up was planned. Results: The CTP was successfully applied in 16 patients (72.8%); in 6 it was not possible because of stiffness of the GI wall and of the tumor. Amylase arose in 3 of 16 patients; none had clinical signs of pancreatitis. Late complications arose in 4 cases: 3 were mostly related to tumor progression. Median postablation survival time was 6 months. A CT scan was performed in all patients, but only in 6 of 16 was it possible to clearly define the tumor margins after ablation. In these patients, the tumor appeared smaller compared with the initial mass (P =.07). Limitations: Small sample of patients, difficulty of objectifying the size of the ablated zone by CT scan. Conclusion: EUS-guided CTP ablation is feasible and safe. Further investigations are needed to demonstrate progression-free survival and local control.

Original languageEnglish
Pages (from-to)1142-1151
Number of pages10
JournalGastrointestinal Endoscopy
Volume76
Issue number6
DOIs
Publication statusPublished - Dec 2012

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

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