Adding RFA to chemotherapy fails to boost survival for locally advanced pancreatic cancer

medwireNews: Radiofrequency ablation (RFA) does not improve overall survival (OS) for patients with locally advanced pancreatic cancer undergoing chemotherapy, report the PELICAN trial investigators.

Finding the combination treatment to also be associated with poorer quality of life (QoL) and a higher rate of grade 3 and worse serious adverse events (AEs) than chemotherapy alone, the team concludes: “These results suggest that clinicians should refrain from RFA in the treatment of [locally advanced pancreatic cancer].”

As reported in JAMA Network Open, the study included 188 patients (53% men, median age 65 years) with unresectable but stable disease after undergoing 2 months of induction chemotherapy consisting of four cycles of a modified FOLFIRINOX regimen or two cycles of gemcitabine plus nab-paclitaxel regimen.

The participants were randomly assigned to receive a further eight cycles of modified FOLFIRINOX or six cycles of gemcitabine plus nab-paclitaxel with (n=93) or without (n=95) RFA. RFA was conducted with bipolar probes via laparotomy at a power of 1 Watt/mm with the number of RFA needles dependent on the size and location of the tumor.

All patients underwent diagnostic laparoscopy to exclude occult metastases, followed by laparotomy to confirm the tumor was unresectable, at which time they were randomly assigned whether or not to receive RFA during the surgery, the researchers explain.

After a median follow-up of 55.0 months, the median OS duration was a comparable 12.1 months with RFA and 11.6 months without RFA. There was also no significant difference in the median progression-free survival duration between the groups, at 5.8 versus 6.9 months, respectively.

However, RFA-treated patients experienced significantly more grade 3 and more severe serious AEs than those given chemotherapy alone (27 vs 11%), with 7% of the group reporting RFA-related serious AEs of this severity, and one patient dying from a possible treatment-related event.

RFA was also associated with clinically relevant decreases in Global Health Status QoL scores from baseline, at 1 month (14.6), 3 months (12.0), and 18 months (18.4), whereas chemotherapy alone was not associated with clinically relevant changes in QoL at any time point.

Indeed, the RFA-treated patients experienced clinically relevant declines in QoL on 67% of the 21 subscales, compared with just 33% among those given chemotherapy only. These included reports of more pain, digestive issues, and a lower body image at 1 month than their chemotherapy-only counterparts, and more nausea and vomiting, and diarrhea at both months 3 and 6.

“These declines in QoL are most likely related to the postoperative recovery of RFA,” comment I Quintus Molenaar (UMC Utrecht Cancer Center, the Netherlands) and co-authors.

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JAMA Netw Open 2026; doi:10.1001/jamanetworkopen.2026.3861