Advances in radiofrequency ablation for pancreatic cancer

Table 2 Representative endoscopic ultrasound-guided radiofrequency ablation combined with systemic therapy in pancreatic cancer

Design & sample	Key outcomes	Combination benefit	Ref.
Prospective cohort: 22 PDAC patients, 19 received systemic gemcitabine-based chemotherapy	OS = approximately 24 months; only 1 patient had peritonitis as AE	Patients had significantly prolonged survival with EUS-RFA + chemotherapy	Oh et al[32], 2022
Matched analysis: 11 EUS-RFA + chemo patients vs 35 chemo-only controls	Median OS 14 months vs 6.1 months; HR = 0.38, P = 0.016; PFS improved at 6 months and 12 months	EUS-RFA doubled survival and progression-free intervals compared to chemo alone	Kongkam et al[31], 2025
Prospective case series: 10 PDAC patients (locally advanced/metastatic) + concurrent standard chemotherapy	Median OS = 20.5 months (95%CI: 9.93-42.2); tumor regression in 6/10 patients; no major AE; long-term survivors (61 months and 81 months)	EUS-RFA was safe, improved outcomes beyond SEER/clinical trial median survival; 1 case converted to resection	Thosani et al[28], 2022
Open-label pilot observational study: 14 EUS-RFA + chemo vs 14 chemo-only in unresectable PDAC	100% vs 50% tumor necrosis (P = 0.014); pain meds significantly reduced in RFA group; tumor grew in chemo-only group (P = 0.017)	RFA group had significantly higher necrosis rate and reduced narcotic usage; minimal AE (1/30 procedures, 3.3%)	ERAP study[33], 2023

PDAC: Pancreatic ductal adenocarcinoma; RFA: Radiofrequency ablation; OS: Overall survival; EUS-RFA: Endoscopic ultrasound-guided radiofrequency ablation; AE: Adverse event; HR: Hazard ratio.