RFA Fails to Improve Outcomes in Locally Advanced Pancreatic Cancer | JAMA Network Open
Introduction
Locally advanced pancreatic cancer (LAPC) remains a highly lethal disease with limited therapeutic options and poor long-term survival. For patients who remain unresectable after induction chemotherapy, local ablative strategies such as radiofrequency ablation (RFA) have been explored as a means to improve local control, prolong survival and potentially enhance quality of life.
Problem Statement
Although RFA has shown feasibility and encouraging outcomes in observational studies, high-quality randomized evidence supporting its use in LAPC has been lacking. Whether adding RFA to standard chemotherapy improves survival or symptom burden in patients with non progressive LAPC after induction chemotherapy has remained an important unanswered clinical question.
Summary
The PELICAN randomized clinical trial demonstrates that adding RFA to chemotherapy does not improve outcomes in patients with non progressive LAPC after induction chemotherapy. In this multicenter phase 3 trial, RFA combined with chemotherapy failed to improve overall survival or progression-free survival compared with chemotherapy alone. Importantly, the addition of RFA was associated with significantly more serious adverse events and consistently worse quality of life across multiple domains, including global health status, pain and digestive symptoms. These findings directly challenge prior observational data suggesting a benefit for local ablative therapy in LAPC and provide the strongest evidence to date against routine use of RFA in this setting. While RFA had been proposed as a strategy to improve local disease control or augment systemic therapy, this trial found no meaningful oncologic advantage and demonstrated clear treatment-related burden. The study strongly supports continued chemotherapy-based management as the preferred standard for unresectable LAPC after induction therapy and argues against the routine incorporation of RFA outside highly selected investigational settings.
