Efficacy of EUS-RFA in pancreatic tumors: Is it ready for prime time? A systematic review and meta-analysis

Abstract

Background and study aims Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) can be used in patients with unresectable pancreatic ductal adenocarcinoma (PDAC). We performed a systematic review and meta-analysis to evaluate the efficacy of EUS-RFA in treatment of locally advanced unresectable PDAC and other pancreatic tumors.

Patients and methods A comprehensive search was done of multiple electronic databases and conference proceedings including PubMed, EMBASE, Web of Science databases, Google Scholar and manual search of references (from inception through May 2019) to identify the studies reporting use of EUS-RFA for pancreatic lesions. The primary outcome was to evaluate technical and clinical success of the procedure. The secondary outcome was to study overall adverse events (AEs).

Results Thirteen studies reporting 165 EUS-RFA procedures on 134 patients were included. Of 134 patients, 27.94 % (38) had unresectable locally advanced PDAC, 40 % (53) had PNETs, 3 % (4) had metastasis to the pancreas and 30 % (41) had other lesions. The pooled technical success rate calculated out of the total number of procedures was 100 % (95 % CI [99.18 – 100], I2 = 0 %). The pooled clinical success rate calculated out of the total number of patients was 91.58 % (95 % CI [82.5 – 98.08], I2 = 21.5 %). The pooled overall AE rates were 14.67 % (95 % CI [4.77 – 27.46], I2 = 56.19 %) out of which abdominal pain was the most common with 9.82 % (95 % CI [3.34 – 18.24], I2 = 23.76 %). Low to moderate heterogeneity was noted.

Conclusion EUS-RFA has high technical (100 %) and clinical success (91.5 %) rates. Further multicenter trials are needed to further validate our findings.

Publikationsverlauf

Eingereicht: 16. April 2020

Angenommen: 12. Juni 2020

Artikel online veröffentlicht:
22. September 2020

• References

• 1 Barthet M, Giovannini M, Lesavre N. et al. Endoscopic ultrasound-guided radiofrequency ablation for pancreatic neuroendocrine tumors and pancreatic cystic neoplasms: a prospective multicenter study. Endoscopy 2019; 51: 836-842
• 2 National Comprehensive Cancer Network. NCCN Clinical practice guidelines in oncology. Pancreatic adenocarcinoma.Version 2. 2016 http://wwwnccnorg/professionals/physician_gls/pdf/pancreaticpdf
• 3 Scopelliti F, Pea A, Conigliaro R. et al. Technique, safety, and feasibility of EUS-guided radiofrequency ablation in unresectable pancreatic cancer. Surg Endosc 2018; 32: 4022-4028
• 4 Song TJ, Seo DW, Lakhtakia S. et al. Initial experience of EUS-guided radiofrequency ablation of unresectable pancreatic cancer. Gastrointest Endosc 2016; 83: 440-443
• 5 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals Int Medic 2009; 151: 264-269
• 6 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-605
• 7 Choi JH, Seo DW, Song TJ. et al. Endoscopic ultrasound-guided radiofrequency ablation for management of benign solid pancreatic tumors. Endoscopy 2018; 50: 1099-1104
• 8 De la Serna C, Cimavilla M, Madrigal B. et al. Su1384 EUS-Guided radiofrequency ablation (EUS-RFA) for pancreatic neuroendocrine tumors and cystic mucinous neoplasms: a pilot study of safety, feasibility and efficacy. Gastrointest Endosc 2018; 87: AB332-AB333
• 9 Crino SF, D'Onofrio M, Bernardoni L. et al. EUS-guided Radiofrequency Ablation (EUS-RFA) of Solid Pancreatic Neoplasm Using an 18-gauge Needle Electrode: Feasibility, Safety, and Technical Success. J Gastrointestin Liver Dis 2018; 27: 67-72
• 10 Lakhtakia S, Ramchandani M, Galasso D. et al. EUS-guided radiofrequency ablation for management of pancreatic insulinoma by using a novel needle electrode (with videos). Gastrointest Endosc 2016; 83: 234-239
• 11 Oleinikov K, Dancour A, Epshtein J. et al. Endoscopic ultrasound-guided radiofrequency ablation: a new therapeutic approach for pancreatic neuroendocrine tumors. J Clin Endocrinol Metab 2019; 104: 2637-2647
• 12 Thosani N, Sharma NR, Raijman I. et al. 483 Safety and efficacy of endoscopic ultrasound guided radiofrequency ablation (EUS-RFA) in the treatment of pancreatic lesions: a multi-center experience. Gastrointest Endosc 2018; 87: AB84
• 13 Goyal D, Cen P, Wray CJ. et al. 1111 Feasibility, Safety, and efficacy of endoscopic ultrasound (eus) guided radiofrequency ablation (RFA) of the pancreatic lesions: single center US experience. Gastrointest Endosc 2017; 85: AB144
• 14 Malikowski T, Gleeson FC, Block M. et al. Mo1268 Endoscopic ultrasound guided radiofrequency ablation (EUS-RFA): initial assessment of safety and efficacy. Gastrointest Endosc 2017; 85: AB484
• 15 Pai M, Habib N, Senturk H. et al. Endoscopic ultrasound guided radiofrequency ablation, for pancreatic cystic neoplasms and neuroendocrine tumors. World J Gastrointest Surg 2015; 7: 52-59
• 16 Wang D, Jin Z, Lei W. et al. Mo1524 endoscopic ultrasound guided radiofrequency ablation for the treatment of advanced pancreatic carcinoma. Gastrointest Endosc 2013; 77: AB414
• 17 Barret M, Leblanc S, Rouquette A. et al. EUS-guided pancreatic radiofrequency ablation: preclinical comparison of two currently available devices in a pig model. Endosc Int Open 2019; 7: E138-E143
• 18 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
• 19 Sutton AJ, Abrams KR, Jones DR. et al. Methods for meta-analysis in medical research. Chichester: Wiley; 2000
• 20 Higgins JPT, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
• 21 Kanwal F, White D. “Systematic Reviews and Meta-analyses” in clinical gastroenterology and hepatology. Clin Gastroenterol Hepatol 2012; 10: 1184-1186
• 22 Guyatt GH, Oxman AD, Kunz R. et al. GRADE guidelines: 7. Rating the quality of evidence—inconsistency. J Clin Epidemiol 2011; 64: 1294-1302
• 23 Larghi A, Rizzatti G, Rimbaş M. et al. EUS-guided radiofrequency ablation as an alternative to surgery for pancreatic neuroendocrine neoplasms: Who should we treat?. Endosco Ultrasound 2019; 8: 220-226