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Feasibility and safety of EUS-guided cryothermal ablation in patients with locally advanced pancreatic cancer.

Abstract：

BACKGROUND:New therapies are needed for pancreatic cancer. OBJECTIVE:To determine the feasibility and safety of a new endoscopic treatment. Secondary endpoints were to determine effects on tumor growth measured with CT scan and to find the overall survival. DESIGN:A cohort study of patients with local progression of advanced pancreatic adenocarcinoma after neoadjuvant therapy. The cryotherm probe (CTP), a flexible bipolar device that combines radiofrequency with cryogenic cooling, was used under EUS guidance. SETTING:San Raffaele Hospital, Milan, Italy; University Medical Center, Hamburg-Eppendorf, Germany. PATIENTS:A total of 22 patients (male/female 11/11; mean age 61.9 years) were enrolled from September 2009 to May 2011. INTERVENTION:Radiofrequency heating: 18 W; pressure for cooling: 650 psi (Pounds per Square Inch); application time: depending on tumor size. MAIN OUTCOME MEASUREMENTS:Feasibility was evaluated during the procedure. A clinical and radiologic follow-up was planned. RESULTS:The CTP was successfully applied in 16 patients (72.8%); in 6 it was not possible because of stiffness of the GI wall and of the tumor. Amylase arose in 3 of 16 patients; none had clinical signs of pancreatitis. Late complications arose in 4 cases: 3 were mostly related to tumor progression. Median postablation survival time was 6 months. A CT scan was performed in all patients, but only in 6 of 16 was it possible to clearly define the tumor margins after ablation. In these patients, the tumor appeared smaller compared with the initial mass (P = .07). LIMITATIONS:Small sample of patients, difficulty of objectifying the size of the ablated zone by CT scan. CONCLUSION:EUS-guided CTP ablation is feasible and safe. Further investigations are needed to demonstrate progression-free survival and local control.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Arcidiacono PG,Carrara S,Reni M,Petrone MC,Cappio S,Balzano G,Boemo C,Cereda S,Nicoletti R,Enderle MD,Neugebauer A,von Renteln D,Eickhoff A,Testoni PA

doi

10.1016/j.gie.2012.08.006

subject

Has Abstract

pub_date

2012-12-01 00:00:00

pages

1142-51

issue

6

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(12)02576-X

journal_volume

76

pub_type

临床试验,杂志文章

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