International Session（Symposium）6(JSGE・JGES・JSGS・JSGCS)
Fri. November 6th   9:00 - 12:00   Room 11: Portopia Hotel South Wing Topaz
IS-S6-8_G
 Recent Advancement in Pancreatic Cancer: Radiofrequency Ablation
Dong-Wan Seo
Asan Medical Center, University of Ulsan College of Medicine
Pancreatic cancer is one of the most difficult tumors to control and there has been no significant survival prolongation even after introduction of improved chemotherapy and radiotherapy. Single modality treatment showed limitations and combined treatment with different modalities may prolong the survival.
Percutaneous radiofrequency ablation (RFA) is local treatment modality which has been used widely for liver, thyroid and renal tumors. Recently EUS-guided RFA (EUS-RFA) was introduced and applied to benign and malignant pancreatic and peripancreatic tumors. Our group conducted a pilot study and applied this new technique to 6 patients with advanced pancreatic cancer for the local ablation of tumor. Our conclusions were that EUS-RFA is technically feasible and relatively safe and it can cause local ablation of pancreatic cancer. There are, however, several technical limitations. First, RFA electrode is 19G and relatively stiff. Therefore it is difficult to target lesions located in an angulated scope position. Second, pancreatic cancer is located close to vital organs such as visceral artery, portal vein, IVC and duodenum. To eradicate tumor cells, large volume ablation is necessary. But it is not possible due to close proximity of pancreatic cancer to vital organs. Therefore single modality treatment can not eradicate cancer cells and combined treatment with chemotherapy and radiotherapy is necessary. In 22 patients with locally advanced unresectable pancreatic cancer, EUS-RFA for local treatment and GP chemotherapy for systemic treatment were combined. In 8 patients, stereotactic body radiation therapy (SBRT) were also added. Mean age was 63 + 6.6yr (M:F=13:9) and the tumor was located in the head (n=15), body (n=4) and tail (n=3). When we analyzed the survival, 1 YSR was 71.4% and 2 YSR was 56.3%. Median survival in unresectable pancreatic cancer was more than 2 years. EUS-RFA can be combined with systemic chemotherapy and SBRT for local management of pancreatic cancer and this combined treatment seems to prolong the survival significantly. However, more data are required before generalized use of EUS-RFA.
Index Term 1: Pancreas cancer
Index Term 2: EUS-RFA, radiofrequency ablation
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