Introduction: EUS-RFA is rapidly emerging as a possible treatment alternative for patients with pNENs who are poor surgical candidates.
Aim(s): To summarize our experience in terms of feasibility, safety and efficacy of EUS-RFA in a cohort of patients with functional and non-functional pNENs.
Materials and methods: Retrospective case series of pNENs patients treated with EUS-RFA at two tertiary referral centers in Israel between March 2017 and October 2018.
Results: Eighteen consecutive pNENs patients that underwent EUS-RFA have been included (11 males, median age of 62.5 (range 28 82)). A total of 27 lesions with a median size of 13 mm (range 4.529) were treated. The location of the target lesion was: head (n=10), body (n=8), uncinate process (n=5) and tail (n=2); in two patients, synchronous liver and lymph node metastasis underwent RFA. Functionally, the tumors were non-functional pNENs and insulinomas in 11 and 7 patients respectively. All tumors were well-differentiated based on Ki-67. Technical success, defined as post RFA changes in tumor vascularity and/or tumor necrosis on surveillance imaging was reported in 26/27 lesions. Normalization of glucose levels was observed in all (7/7) insulinomas within 24 h. There were no major complications 48 h post-RFA. Two patients developed mild pancreatitis post-RFA that resolved within 72 hours. No recurrences were observed during a median follow up of 6 months (range 120 m).
Conclusion: EUS-RFA for highly selected pNENs patients who cannot or do not want to undergo surgical resection appears to be safe and feasible. Prospective studies comparing RFA with surgical excision, including larger cohorts of patients and longer follow-up periods, are warranted to establish the role of EUS-RFA in the treatment algorithm for pNENs.
18 - 21 May 2019
European Society of Endocrinology