In the spotlight today is Dr. Stephen P Pereira and team in the UK at UCLH, who have published a very positive case about the treatment of a pancreatic neuroendocrine tumor (pNET) with the Habib™ EUS RFA device.
The 18mm tumor in the head of the pancreas of the 70-year-old female patient, was identified on CT scan and confirmed with EUS visualization and FNA. The patient was a poor candidate for surgery, so when other initial therapies (Diazoxide, low GI diet) were not successful, the team proceeded to RFA.
As you will see, the authors support the use of EUS-RFA treatment in the management of patients with functional pancreatic neuroendocrine tumors who have failed multiple therapies and cannot undergo surgery due to comorbidities.
"After the final EUS-RFA treatment, the patient's glucose requirements ceased and octreotide therapy was withdrawn...the patient remained well and asymptomatic at 10 months follow-up."
In 2009, a similar case was reported (15mm pNET located in tail of pancreas) where the patient was successfully treated with CT-guided percutaneous RFA. While this demonstrates the fundamentals of RFA at work on a similar tumor, the benefit of EUS access today is a smaller and more manoeuvrable device that can reach more challenging anatomical spaces such as the tail of the pancreas. Smaller devices used at lower power settings have been developed in an attempt to reduce complications.
Reported results from 2015 on larger-sized (27.5mm) unresectable pNETs showed that EUS RFA therapy was safe and straightforward, and this case from Dr. Pereira further demonstrates the success potential of the therapy where indicated.
The full publication of the recent pNET case can be accessed here, and below is an exclusive video of Dr. Pereira discussing the case during a meeting at Hammersmith Hospital late last year.
While this case shows one use for EUS RFA, others are in process, including the randomized controlled RADIOCYST trial and several others which will be discussed at the upcoming EUS & HPB RFA Focus Group at DDW (more info and schedule here).