Pancreatic Ductal Adenocarcinoma (PDAC)
Conditions
Keywords
EUS-RFA, Endoscopic Ultrasound-Guided Radiofrequency Ablation, Locally Advanced Pancreatic Cancer
Brief summary
The purpose of this study is to evaluate whether endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) affects survival in patients with inoperable pancreatic carcinoma. By using a prospective single-arm design with historical controls, this study aims to generate clinically relevant data while minimizing the number of patients exposed to experimental treatment. The findings may support future integration of EUS-RFA into standard care for this high-need patient population.
Interventions
A 19G RFA needle (EUSRA, STARMed, Gyeonggi-do, South Korea) is introduced through the working channel of an echoendoscope and advanced into the pancreatic tumor under real-time ultrasound guidance. The needle is connected to a dedicated RF generator delivering a current of 400-500 kHz, which induces coagulative necrosis in the targeted tissue. Treatment is continued until complete ablation is confirmed ultrasonographically, or until an impedance value of 800 Ω is reached, at which point the generator automatically terminates power output to limit further tissue damage. A cooling pump circulates chilled saline through the needle to reduce charring at the ablation site. The procedure is performed transgastrically or transduodenally under deep sedation or general anesthesia, and may involve one or more ablation cycles per session. Treatment may be repeated at approximately 4-week intervals, depending on radiological response and patient tolerance.
Sponsors
Bojan Kovacevic
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
A historical control group will be used as a comparitor.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult habile patients with a signed informed consent * Histologically confirmed pancreatic carcinoma ≤5 cm in largest diameter * ECOG performance status 0-2 * Patients not eligible for curative-intended surgical treatment due to: Advanced (unresectable) disease, or Unsuitability for surgery due to comorbidities or poor performance status, or Patient preference to decline surgery
Exclusion criteria
* Metastatic disease * Uncorrected coagulopathy (INR ≥1.5 or thrombocyte count \< 50 mia/L) * Altered anatomy or interposition of major vessels precluding safe EUS-RFA * Active untreated infection or pancreatitis * Life expectancy \<3 months * Prior local ablative treatment interfering with outcome
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall survival | From index date until death from any cause, assessed up to 4 years | Time from index date (first day of systemic oncological therapy or first visit at the Department of Oncology (for patients who do not receive systemic therapy)) to death from any cause. Participants alive at the time of last follow-up will be censored at that date. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression- and metastatic-free survival | From index date until progression, metastasis, or last follow-up, assessed up to approximately 4 years | Time from index date to radiological progression of the primary tumor or development of distant metastases, assessed according to RECIST 1.1 on cross-sectional imaging. |
| Local tumor control at 6 and 12 months | At 6 and 12 months after index date | Proportion of participants with local tumor control (absence of local progression) on cross-sectional imaging at 6 and 12 months, assessed according to RECIST 1.1. |
| Procedure-related adverse events | At 30 days after each EUS-RFA procedure | Adverse events occurring within 30 days of each EUS-RFA treatment, graded according to the AGREE classification. |
| Time to biliary/duodenal intervention | From index date until intervention or last follow-up, assessed up to approximately 4 years | Time from index date to first biliary or duodenal intervention (e.g., stenting) |
| Pain score change compared to baseline | Baseline and at 6, 12 and 18 months after inclusion | Change from baseline in pain severity, measured using a Numeric Rating Scale (NRS, 0-10) |
| Opioid consumption change compared to baseline | Baseline and at 6, 12 and 18 months after inclusion | Change in opioid consumption, converted to total daily oral morphine milligram equivalent (MME). |
| Quality of Life change compared to baseline (EORTC QLQ-C30) | Baseline and at 6, 12 and 18 months | Change from baseline in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), Global Health Status/Quality of Life scale, ranging from 0 (worst) to 100 (best), with higher scores indicating better quality of life. |
Contacts
CONTACTClara Søndersted, MD
PRINCIPAL_INVESTIGATORBojan Kovacevic, MD, PhD
Herlev Hospital
Outcome results
None listed