Aims:
Aim of the study was to assess the survival outcomes of pts with LA PDAC treated with
chemotherapy ± radiotherapy (CT ± RT) plus endosonography-guided HybridTherm ablation
(EUS-HTP) vs. those receiving only CT ± RT.
Methods:
Pts with LA PDAC, with local disease progression (PD) after first-line CT ± RT or
unfit for CT (cases), prospectively treated by HTP (2010 – 2016), were retrospectively
compared to similar pts not treated by HTP (controls). HTP (ERBE, Germany) is a bipolar
probe combining radiofrequency with cryogenic cooling. Parametric/non-parametric tests
and Log-rank Mantel-Cox tests for group differences were used (p ≤0.05 as significant).
Results:
19/19 cases/controls were included. Five cases did not receive CT ± RT before EUS-HTP
due to concomitant comorbidity. The 2 groups had no difference regarding features
at diagnosis (sex, age, lesion site and size, serum CA19.9, CT scheme and duration)
and after first-line treatment (lesion size, serum Ca 19 – 9, progression-free survival
time). EUS-HTP was performed ≥2 times in 7 cases. OS in cases vs. controls from diagnosis,
first-line CT ± RT onset and local PD was similar (p = 0.22; p = 0.82; p = 0.54),
as well as in the group of pts treated with further CT ± RT (p = 0.12; p = 0.68; p
= 0.94). OS was significantly longer from local PD in cases compared to controls who
did not undergo second-line CT ± RT (p = 0.05). OS in cases from EUS-HTP was 6 months,
with no difference between pts treated with HTP only and those receiving concomitant
CT ± RT (p = 0.18), and OS significantly longer in pts treated with ≥2 sessions vs.
1 session (p = 0.007).
Conclusions:
In pts with LA PDAC and local PD after first-line CT ± RT and unfit for a second-line
treatment, EUS-HTP may obtain longer OS compared to palliative care. The increase
of OS in pts treated by ≥2 EUS-HTP may suggest that repeated sessions can achieve
a better disease control. A randomized controlled study comparing EUS-HTP plus CT
± RT vs. CT ± RT is ongoing and will better assess EUS-HTP efficacy.
