Endoscopic Ultrasound-Guided Radiofrequency Ablation: A New Therapeutic Approach for Pancreatic Neuroendocrine Tumors

J Clin Endocrinol Metab. 2019 Jul 1;104(7):2637-2647. doi: 10.1210/jc.2019-00282.

Abstract

Context: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is rapidly emerging as feasible therapy for patients with pancreatic neuroendocrine tumors (pNETs) in selected cases, as a result of its favorable safety profile.

Objective: To assess the feasibility, safety, and efficacy of EUS-RFA in a cohort of patients with functional and nonfunctional pNETs (NF-pNETs).

Design: Data on pNET patients treated with EUS-RFA between March 2017 and October 2018 at two tertiary centers was retrospectively analyzed.

Results: The cohort included 18 adults (eight women, 10 men), aged 60.4 ± 14.4 years (mean ± SD), seven insulinoma patients, and 11 patients with NF-pNETs. Twenty-seven lesions with a mean diameter of 14.3 ± 7.3 mm (range 4.5 to 30) were treated. Technical success defined as typical postablative changes on a surveillance imaging was achieved in 26 out of 27 lesions. Clinical response with normalization of glucose levels was observed in all (seven of seven) insulinoma cases within 24 hours of treatment. Overall, there were no major complications 48 hours postprocedure. No clinically significant recurrences were observed during mean follow-up of 8.7 ± 4.6 months (range 2 to 21 months).

Conclusions: EUS-guided RFA of pNETs is a minimally invasive, safe, and technically feasible procedure for selected patients.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Blood Glucose / analysis
  • Catheter Ablation / adverse effects
  • Catheter Ablation / methods*
  • Endosonography
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Insulinoma / blood
  • Insulinoma / diagnostic imaging
  • Insulinoma / pathology
  • Insulinoma / surgery*
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Recurrence, Local / prevention & control*
  • Neuroendocrine Tumors / blood
  • Neuroendocrine Tumors / diagnostic imaging
  • Neuroendocrine Tumors / pathology
  • Neuroendocrine Tumors / surgery*
  • Pancreas / diagnostic imaging
  • Pancreas / pathology
  • Pancreas / surgery
  • Pancreatic Neoplasms / blood
  • Pancreatic Neoplasms / diagnostic imaging
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / surgery*
  • Retrospective Studies
  • Treatment Outcome
  • Ultrasonography, Interventional

Substances

  • Blood Glucose

Supplementary concepts

  • Non functioning pancreatic endocrine tumor