Radiofrequency: Treatment of Tumors of the Pancreas by Echoendoscopic Route. Interview with Dr. Alberto Leonardo Larghi.

Kill neoplastic cells with heat. Thanks to echoendoscopic radiofrequency, it is possible to reach and treat tumors located in otherwise difficult to access sites of the body, such as the pancreas: a very safe procedure, with a low rate of complications compared to surgery, successfully used in the treatment of pancreatic tumors and whose clinical use is greatly increasing. We talk about it with Dr. Alberto Leonardo Larghi, gastroenterologist, pancreatologist and echoendoscopist of UPMC Salvator Mundi International Hospital, expert, among other things, in the treatment with radiofrequency of pancreatic tumors of neuroendocrine type and adenocarcinoma, pancreatic metastases from other tumors and neoplastic lesions of another nature.

Dr. Larghi, let's briefly explain what Radiofrequency is and how it works.

Radiofrequency (RFA) is an ablative treatment, based on the potential difference between two electrodes, which generates electrical voltage and, consequently, localized heat that allows to kill neoplastic cells. In gastroenterology, the main indication is RFA treatment of primary liver cancer performed percutaneously.

Are there other indications for rfa treatment of gastroenteric tract diseases?

Recently, a needle has been produced from RFA used specifically under echoendoscopy guidance (EUS-RFA). Through this needle you can treat otherwise hard-to-reach sites, such as the pancreas, mediastinum and pelvis. The main indications are pancreatic tumors (neuroendocrine and adenocarcinoma), pancreatic metastases from other tumors and, experimentally, other tumors such as relapsing gynecological and renal ones that do not respond to immunotherapy.

Regarding neuroendocrine tumors of the pancreas, when and why do you prefer treatment with RFA by echoendoscopic route?

Historically, the treatment of neuroendocrine tumors of the pancreas is surgery, which, however, is burdened with mortality (up to 3%) and the occurrence of complications (up to 40%). In functioning tumors, that is, that produce an excess of hormones that cause symptoms, EUS-RFA has now become the treatment of choice. For small non-functioning tumors (<2cm), usually diagnosed incidentally and completely asymptomatic, EUS-RFA can avoid the patient the risks and complications of surgery, with very promising results in terms of effectiveness.

What is the role of EUS-RFA in pancreatic adenocarcinoma, a very aggressive and lethal tumor?

In this type of cancer, the role of EUS-RFA is less predominant than in neuroendocrine tumors. It is in fact for the moment used as a loco-regional treatment in patients who have carried out all possible therapeutic approaches or in case of recurrence.

Dr. Larghi, what types of metastases to the pancreas are treated with EUS-RFA?

Currently the metastases most frequently treated with EUS-RFA are those from renal cancer that have a very particular behavior as they can develop many years after the removal of the primary tumor and the pancreas is generally the only site of metastasis. In these cases, the EUS-RFA plays a role when the lesions begin to increase in volume. In my experience I have treated several metastatic lesions to the pancreas from organs such as the colon and lung with excellent results.

Isn't it dangerous to apply heat to such a delicate organ as the pancreas?

Data from the literature indicate that the procedure is very safe, with a low rate of complications. The most feared one, acute pancreatitis, can be prevented through the prophylactic use of non-steroidal anti-inflammatory drugs rectally.

What do you foresee for the future of this method?

I firmly believe that the possibility of easily reaching places of the organism otherwise difficult to access by other means, will lead to the expansion of the use of this technique. A method that also has the ability to increase the immune response against tumor antigens, favoring the association with other oncological therapies such as immunotherapeutics. Potential targets are relapsing gynecological tumors, not very responsive to therapies; metastatic kidney cancers that fail the first line of immunotherapy and potentially many other cancers where immunotherapy is becoming a first-line treatment.