Analysis of Endoscopic Radiofrequency Ablation of Biliary Malignant Strictures in Pancreatic Cancer Suggests Potential Survival Benefit
- 471 Downloads
Pancreatic carcinoma is often inoperable, carries a poor prognosis, and is commonly complicated by malignant biliary obstruction. Phase I/II studies have demonstrated good safety and early stent patency using endoscopic biliary radiofrequency ablation (RFA) as an adjunct to self-expanding metal stent (SEMS) insertion for biliary decompression.
To analyze the clinical efficacy of endobiliary RFA.
Retrospective case–control analysis was carried out for 23 patients with surgically unresectable pancreatic carcinoma and malignant biliary obstruction undergoing endoscopic RFA and SEMS insertion and 46 controls (SEMS insertion alone) in a single tertiary care center. Controls were stringently matched for age, sex, metastases, ASA/comorbidities. Survival, morbidity, and stent patency rates were assessed.
RFA and control groups were closely matched—ASA 2.35 ± 0.65 versus 2.54 ± 0.50, p = 0.086; metastases 9/23 (39.1 %) versus 18/46 (39.1 %), p = 0.800; chemotherapy 16/23 (69.6 %) versus 24/46 (52.2 %), p = 0.203. Median survival in RFA group was 226 days (IQR 140–526 days) versus 123.5 days (IQR 44–328 days) in controls (p = 0.010). RFA was independently predictive of survival at 90 days (OR 21.07, 95 % CI 1.45–306.64, p = 0.026) and 180 days (OR 4.48, 95 % CI 1.04–19.30, p = 0.044) in multivariate analysis. SEMS patency rates were equivalent in both groups. RFA was well tolerated with minimal side effects.
Endoscopic RFA is a safe and efficacious adjunctive treatment in patients with advanced pancreatic malignancy and biliary obstruction and may confer early survival benefit. Randomized prospective clinical trials of this new modality are mandated.
KeywordsBiliary metal stent Malignant biliary stricture Therapeutic endoscopy Obstructive jaundice
- 2.Herrmann R, Bodoky G, Ruhstaller T, et al. Gemcitabine plus capecitabine compared with gemcitabine alone in advanced pancreatic cancer: a randomized, multicenter, phase III trial of the Swiss Group for Clinical Cancer Research and the Central European Cooperative Oncology Group. J Clin Oncol. 2007;25:2212–2217.CrossRefPubMedGoogle Scholar
- 20.Hansler J, Wissniowski TT, Schuppan D, et al. Activation and dramatically increased cytolytic activity of tumor specific T lymphocytes after radio-frequency ablation in patients with hepatocellular carcinoma and colorectal liver metastases. World J Gastroenterol. 2006;12:3716–3721.PubMedCentralPubMedGoogle Scholar