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.
