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. 2021 Oct 20;13(21):5267.
doi: 10.3390/cancers13215267.

Endoscopic Ultrasound-Guided Radiofrequency Ablation as an Future Alternative to Pancreatectomy for Pancreatic Metastases from Renal Cell Carcinoma: A Prospective Study

Brice Chanez  1   2   3 , Fabrice Caillol  4 , Jean-Philippe Ratone  4 , Christian Pesenti  4 , Philippe Rochigneux  1   2   3 , Géraldine Pignot  5 , Jeanne Thomassin  6 , Serge Brunelle  7 , Jochen Walz  5 , Naji Salem  8 , Marc Giovannini  4 , Gwenaelle Gravis  1   2
Affiliations

Endoscopic Ultrasound-Guided Radiofrequency Ablation as an Future Alternative to Pancreatectomy for Pancreatic Metastases from Renal Cell Carcinoma: A Prospective Study

Brice Chanez et al. Cancers (Basel). .

Abstract

Background: Pancreatic metastases (PM) from renal cell carcinoma (RCC) are rare, are associated with favorable outcomes and are usually handled by surgery or VEGFR inhibitors, which both have side effects. Endoscopic Ultrasound (EUS)-guided radiofrequency ablation (RFA) is an innovative approach to treat focally deep metastases and could be a relevant technique to control PM from RCC.

Methods: This monocentric, prospective study aimed to evaluate the safety and efficacy of EUS-RFA to treat PM. We included patients with confirmed and progressive PM from RCC. PM was ablated under general anesthesia with a linear EUS scope and a EUS-RFA 19-gauge needle electrode placed into the tumor.

Results: Twelve patients from Paoli-Calmettes Institute were recruited between May 2017 and December 2019. Median age was 70.5 years (range 61-75), 50% were female, 100% were ECOG 0-1. At inclusion, mean PM size was 17 mm (range 3-35 mm); and all were progressive before EUS-RFA. Seven patients had EUS-RFA as the only treatment for RCC. We performed 26 EUS-RFA procedures and 21 PM was ablated. Median follow up was 27.7 months (range 6.4-57.1). For evaluable PM, the 6- and 12-month focal control rates were 84% and 73% respectively. One patient treated with TKI developed a paraduodenal abscess 2 months after EUS-RFA and another patient with biliary stent developed hepatic abscesses few days after EUS-RFA. No other severe side effects were experienced.

Conclusions: in this series, which is the largest ever reported, we showed that EUS-RFA is feasible and yields an excellent local control rate for PM from mRCC. With manageable complications, it could be a valuable alternative to pancreatic surgery in well-selected patients.

Keywords: endoscopy; glandular metastases; pancreatic metastases; radiofrequency ablation; renal cell carcinoma.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Following contrast enhancing PM with CT-scan before and after EUS-RFA. Abdomen CT-Scan with contrast injection at artery phase, before (A) and after endoscopic radiofrequency ablation of PM in the body of the pancreas, displaying complete response without contrast enhancement in RFA scar ((B) and at magnification (C)). PM: pancreatic metastases, CT: computed tomography, EUS-RFA: Endoscopic Ultra-Sound guided RadioFrequency Ablation.
Figure 2
Figure 2
Patient Progression Free Survival.
See this image and copyright information in PMC

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