Ex-vivo investigation of radiofrequency ablation in pancreatic adenocarcinoma after neoadjuvant chemotherapy

Gemma Rossi; Maria Chiara Petrone; Marco Schiavo Lena; Luca Albarello; Diego Palumbo; Sabrina Gloria Giulia Testoni; Livia Archibugi; Matteo Tacelli; Piera Zaccari; Giuseppe Vanella; Laura Apadula; Stefano Crippa; Giulio Belfiori; Michele Reni; Massimo Falconi; Claudio Doglioni; Francesco De Cobelli; Andrew J Healey; Gabriele Capurso; Paolo Giorgio Arcidiacono

doi:10.1002/deo2.152

Ex-vivo investigation of radiofrequency ablation in pancreatic adenocarcinoma after neoadjuvant chemotherapy

Gemma Rossi^*, Maria Chiara Petrone, Marco Schiavo Lena, Luca Albarello, Diego Palumbo, Sabrina Gloria Giulia Testoni, Livia Archibugi, Matteo Tacelli, Piera Zaccari, Giuseppe Vanella, Laura Apadula, Stefano Crippa, Giulio Belfiori, Michele Reni, Massimo Falconi, Claudio Doglioni, Francesco De Cobelli, Andrew J Healey, Gabriele Capurso, Paolo Giorgio Arcidiacono

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVE: Endoscopic ultrasound (US)-guided radiofrequency ablation (RFA) has been investigated for pancreatic ductal adenocarcinoma (PDAC) but studies are limited and heterogeneous. Computed tomography (CT) scan features may predict RFA response after chemotherapy but their role is unexplored. The primary aim was to investigate the efficacy of ex-vivo application of a dedicated RFA system at three power on surgically resected PDAC in patients who underwent neoadjuvant chemotherapy. The secondary aim was to explore the association between pre-treatment CT-based quantitative features and RFA response.

METHODS: Fifteen ex-vivo PDAC samples were treated by RFA under US control at three power groups (10, 30, and 50 W). Short axis necrosis diameter was measured by two expert blinded pathologists as the primary outcome. Two radiologists independently reviewed preoperative CT images.

RESULTS: Eighty percent of specimens showed coagulative necrosis consisting of few millimeters: 5.7 ± 3.9 mm at 10 W, 3.7 ± 2.2 mm at 30 W, and 3.5 ± 2.4 mm at 50 W ( p = 0.3), without a significant correlation between power setting and mean necrosis short axis (rho = -0.28; p = 0.30). Good agreement was seen between pathologists ( k = 0.76; 95% confidence interval 0.55-0.98). Logistic regression analysis did not show associations between CT features and RFA response.

CONCLUSIONS: RFA causes histologically evident damage with coagulative necrosis of a few millimeters in 80% of ex-vivo PDAC samples after chemotherapy and no clinical or pre-operative CT features can predict efficacy. Power settings do not correlate with the histological ablation area. These results are of relevance when employing RFA in vivo and planning clinical trials on its role in PDAC patients.

Original language	English
Article number	e152
Pages (from-to)	e152
Journal	DEN Open
Volume	3
Issue number	1
DOIs	https://doi.org/10.1002/deo2.152
Publication status	Published - 14 Jul 2022
Externally published	Yes

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Rossi et al. RFA ex-vivo PDAC final DRAFT ajhedit9.1Accepted author manuscript, 147 KBLicence: CC BY
DEN Open - 2022 - Rossi - Ex%u2010vivo investigation of radiofrequency ablation in pancreatic adenocarcinoma after neoadjuvantFinal published version, 1.07 MBLicence: Creative Commons: Attribution (CC-BY)

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Rossi, G., Petrone, M. C., Lena, M. S., Albarello, L., Palumbo, D., Testoni, S. G. G., Archibugi, L., Tacelli, M., Zaccari, P., Vanella, G., Apadula, L., Crippa, S., Belfiori, G., Reni, M., Falconi, M., Doglioni, C., De Cobelli, F., Healey, A. J., Capurso, G., & Arcidiacono, P. G. (2022). Ex-vivo investigation of radiofrequency ablation in pancreatic adenocarcinoma after neoadjuvant chemotherapy. DEN Open, 3(1), e152. Article e152. https://doi.org/10.1002/deo2.152

@article{cb9c5638bf454ef4ba4fac13c75aaa5f,

title = "Ex-vivo investigation of radiofrequency ablation in pancreatic adenocarcinoma after neoadjuvant chemotherapy",

abstract = "OBJECTIVE: Endoscopic ultrasound (US)-guided radiofrequency ablation (RFA) has been investigated for pancreatic ductal adenocarcinoma (PDAC) but studies are limited and heterogeneous. Computed tomography (CT) scan features may predict RFA response after chemotherapy but their role is unexplored. The primary aim was to investigate the efficacy of ex-vivo application of a dedicated RFA system at three power on surgically resected PDAC in patients who underwent neoadjuvant chemotherapy. The secondary aim was to explore the association between pre-treatment CT-based quantitative features and RFA response.METHODS: Fifteen ex-vivo PDAC samples were treated by RFA under US control at three power groups (10, 30, and 50 W). Short axis necrosis diameter was measured by two expert blinded pathologists as the primary outcome. Two radiologists independently reviewed preoperative CT images.RESULTS: Eighty percent of specimens showed coagulative necrosis consisting of few millimeters: 5.7 ± 3.9 mm at 10 W, 3.7 ± 2.2 mm at 30 W, and 3.5 ± 2.4 mm at 50 W ( p = 0.3), without a significant correlation between power setting and mean necrosis short axis (rho = -0.28; p = 0.30). Good agreement was seen between pathologists ( k = 0.76; 95% confidence interval 0.55-0.98). Logistic regression analysis did not show associations between CT features and RFA response. CONCLUSIONS: RFA causes histologically evident damage with coagulative necrosis of a few millimeters in 80% of ex-vivo PDAC samples after chemotherapy and no clinical or pre-operative CT features can predict efficacy. Power settings do not correlate with the histological ablation area. These results are of relevance when employing RFA in vivo and planning clinical trials on its role in PDAC patients.",

author = "Gemma Rossi and Petrone, {Maria Chiara} and Lena, {Marco Schiavo} and Luca Albarello and Diego Palumbo and Testoni, {Sabrina Gloria Giulia} and Livia Archibugi and Matteo Tacelli and Piera Zaccari and Giuseppe Vanella and Laura Apadula and Stefano Crippa and Giulio Belfiori and Michele Reni and Massimo Falconi and Claudio Doglioni and {De Cobelli}, Francesco and Healey, {Andrew J} and Gabriele Capurso and Arcidiacono, {Paolo Giorgio}",

year = "2022",

month = jul,

day = "14",

doi = "10.1002/deo2.152",

language = "English",

volume = "3",

pages = "e152",

journal = "DEN Open",

issn = "2692-4609",

number = "1",

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Rossi, G, Petrone, MC, Lena, MS, Albarello, L, Palumbo, D, Testoni, SGG, Archibugi, L, Tacelli, M, Zaccari, P, Vanella, G, Apadula, L, Crippa, S, Belfiori, G, Reni, M, Falconi, M, Doglioni, C, De Cobelli, F, Healey, AJ, Capurso, G & Arcidiacono, PG 2022, 'Ex-vivo investigation of radiofrequency ablation in pancreatic adenocarcinoma after neoadjuvant chemotherapy', DEN Open, vol. 3, no. 1, e152, pp. e152. https://doi.org/10.1002/deo2.152

TY - JOUR

T1 - Ex-vivo investigation of radiofrequency ablation in pancreatic adenocarcinoma after neoadjuvant chemotherapy

AU - Rossi, Gemma

AU - Petrone, Maria Chiara

AU - Lena, Marco Schiavo

AU - Albarello, Luca

AU - Palumbo, Diego

AU - Testoni, Sabrina Gloria Giulia

AU - Archibugi, Livia

AU - Tacelli, Matteo

AU - Zaccari, Piera

AU - Vanella, Giuseppe

AU - Apadula, Laura

AU - Crippa, Stefano

AU - Belfiori, Giulio

AU - Reni, Michele

AU - Falconi, Massimo

AU - Doglioni, Claudio

AU - De Cobelli, Francesco

AU - Healey, Andrew J

AU - Capurso, Gabriele

AU - Arcidiacono, Paolo Giorgio

PY - 2022/7/14

Y1 - 2022/7/14

N2 - OBJECTIVE: Endoscopic ultrasound (US)-guided radiofrequency ablation (RFA) has been investigated for pancreatic ductal adenocarcinoma (PDAC) but studies are limited and heterogeneous. Computed tomography (CT) scan features may predict RFA response after chemotherapy but their role is unexplored. The primary aim was to investigate the efficacy of ex-vivo application of a dedicated RFA system at three power on surgically resected PDAC in patients who underwent neoadjuvant chemotherapy. The secondary aim was to explore the association between pre-treatment CT-based quantitative features and RFA response.METHODS: Fifteen ex-vivo PDAC samples were treated by RFA under US control at three power groups (10, 30, and 50 W). Short axis necrosis diameter was measured by two expert blinded pathologists as the primary outcome. Two radiologists independently reviewed preoperative CT images.RESULTS: Eighty percent of specimens showed coagulative necrosis consisting of few millimeters: 5.7 ± 3.9 mm at 10 W, 3.7 ± 2.2 mm at 30 W, and 3.5 ± 2.4 mm at 50 W ( p = 0.3), without a significant correlation between power setting and mean necrosis short axis (rho = -0.28; p = 0.30). Good agreement was seen between pathologists ( k = 0.76; 95% confidence interval 0.55-0.98). Logistic regression analysis did not show associations between CT features and RFA response. CONCLUSIONS: RFA causes histologically evident damage with coagulative necrosis of a few millimeters in 80% of ex-vivo PDAC samples after chemotherapy and no clinical or pre-operative CT features can predict efficacy. Power settings do not correlate with the histological ablation area. These results are of relevance when employing RFA in vivo and planning clinical trials on its role in PDAC patients.

AB - OBJECTIVE: Endoscopic ultrasound (US)-guided radiofrequency ablation (RFA) has been investigated for pancreatic ductal adenocarcinoma (PDAC) but studies are limited and heterogeneous. Computed tomography (CT) scan features may predict RFA response after chemotherapy but their role is unexplored. The primary aim was to investigate the efficacy of ex-vivo application of a dedicated RFA system at three power on surgically resected PDAC in patients who underwent neoadjuvant chemotherapy. The secondary aim was to explore the association between pre-treatment CT-based quantitative features and RFA response.METHODS: Fifteen ex-vivo PDAC samples were treated by RFA under US control at three power groups (10, 30, and 50 W). Short axis necrosis diameter was measured by two expert blinded pathologists as the primary outcome. Two radiologists independently reviewed preoperative CT images.RESULTS: Eighty percent of specimens showed coagulative necrosis consisting of few millimeters: 5.7 ± 3.9 mm at 10 W, 3.7 ± 2.2 mm at 30 W, and 3.5 ± 2.4 mm at 50 W ( p = 0.3), without a significant correlation between power setting and mean necrosis short axis (rho = -0.28; p = 0.30). Good agreement was seen between pathologists ( k = 0.76; 95% confidence interval 0.55-0.98). Logistic regression analysis did not show associations between CT features and RFA response. CONCLUSIONS: RFA causes histologically evident damage with coagulative necrosis of a few millimeters in 80% of ex-vivo PDAC samples after chemotherapy and no clinical or pre-operative CT features can predict efficacy. Power settings do not correlate with the histological ablation area. These results are of relevance when employing RFA in vivo and planning clinical trials on its role in PDAC patients.

U2 - 10.1002/deo2.152

DO - 10.1002/deo2.152

M3 - Article

C2 - 35898840

SN - 2692-4609

VL - 3

SP - e152

JO - DEN Open

JF - DEN Open

IS - 1

M1 - e152

ER -

Ex-vivo investigation of radiofrequency ablation in pancreatic adenocarcinoma after neoadjuvant chemotherapy

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