Advances in radiofrequency ablation for pancreatic cancer

Table 1 Representative technological advances in endoscopic ultrasound-guided radiofrequency ablation for pancreatic cancer

Technology	Year	Study design	Sample size/population	Key outcomes	Advances	Ref.
Energy delivery systems	2021	Retrospective cohort	11 patients with unresectable PDAC	100% technical success	Low-power monopolar RFA (5-10 W for 90 seconds per session)	Wang et al[10]
				Tumor size reduction observed in post-op imaging	Multiple sessions (up to 8)
				5/11 patients had CA19-9 reduction	Fine-gauge (19G) RFA needle used to reduce collateral damage
				No major adverse events
Probe designs	2024	Historic single-center cohort	26 patients with unresectable PDAC	100% technical success	High-precision 19G RFA needle with 10-mm active tip	Robles-Medranda et al[16]
				Tumor size reduced from 39.5 mm to 26 mm at 6 months (P = 0.04)	Use of steerable, slim electrodes for better access to tumors near vessels or GI wall
				OS at 6 months: 42.3%	Thermally insulated shaft to minimize injury
				Significant PS improvement
Real-time imaging	2022	Prospective cohort (longitudinal)	10 patients with locally advanced/metastatic PDAC	22 total EUS-RFA sessions across 10 patients	EUS-guided real-time imaging used in all stages (needle placement, ablation monitoring, post-procedure follow-up)	Thosani et al[28]
				Median survival: 20.5 months	Multiple oblique imaging planes used to assess margins
				> 50% tumor regression in 3 patients	Ablation near vascular structures guided with high-resolution Doppler modes
				2 patients alive at 61 and 81 months

PDAC: Pancreatic ductal adenocarcinoma; RFA: Radiofrequency ablation; OS: Overall survival; GI: Gastrointestinal; EUS-RFA: Endoscopic ultrasound-guided radiofrequency ablation; EUS: Endoscopic ultrasound.