ENDOSCOPIC ULTRASOUND-GUIDED RADIOFREQUENCY ABLATION (EUSRFA) AS FOCAL THERAPY FOR PANCREATIC METASTASES FROM RENAL CELL CARCINOMA: A MONOCENTRIC EXPERIENCE

 

Aims Pancreatic metastases (PM) from renal cell carcinoma (RCC) are rare but associated with good prognosis. The usual management of PM is surgery or tyrosine kinase inhibitor (TKI) with sides effects. Endoscopic radiofrequency ablation (EUSRFA) is an innovative approach to focally treat deep metastasis and could be a relevant technic to control PM from RCC.

Methods We report a monocentric, prospective analysis for local control and toxicity in patients treated by EUSRFA for progressive PM from RCC. EUSRFA was performed under general anesthesia, with a linear EUS scope and a 19 G EUSRFA needle.

Results 10 pts were recruited between May 2017 and December 2018. Median age was 72y, 5/10 female. Median number of PM was 2 [1-3]. PM localizations was: head in 40%, body 40%, tail 20% and average size was 14 mm. Six of 10 had other mRCC spread, . We performed 20 EUSRFA procedures over 17 PM. Median number of EUSRFA sessions was 2 per patient [1-3]. With a median follow up of 18 months [4.6-35.6], 58.8% of treated PM was evaluated as complete response (10/18), 17 % as partial response (3/10) and 17 % as stable disease (3/10) at the last CT-evaluation. Only two patients were considered as progressive disease and PM focal control was 89%. Regarding sides effects, 1 patient treated concomitantly with TKI developed a paraduodenal abscess 2 months after EUSRFA and was drained endoscopically and 1 with biliary prothesis developed hepatic abscesses few days after EUSRFA. Regarding the size, all PM treated with diameter of ≤ 20mm was locally control versus only 75% of PM> 20mm.

Conclusions EUSRFA is feasible and displays an excellent local control for PM. Without any major side effect, it could be a valuable option, less morbid than pancreas resection, for well selected patients with progressive PM.