Radiofrequency Ablation Fails to Improve Survival and Worsens Quality of Life in Pancreatic Cancer: JAMA
Netherlands: In a randomized clinical trial of patients with locally advanced pancreatic cancer (LAPC) following 2 months of multiagent chemotherapy, the addition of radiofrequency ablation (RFA) did not improve overall survival compared with chemotherapy alone and was associated with a negative impact on patients’ quality of life.
The findings, published in JAMA Network Open, are from the PELICAN trial led by Leonard W. F. Seelen from UMC Utrecht Cancer Center and St Antonius Hospital, the Netherlands, along with an international team of researchers. The study was designed to evaluate whether adding local ablative therapy with RFA could enhance outcomes in patients with unresectable LAPC who had achieved at least stable disease after initial chemotherapy.
Pancreatic cancer continues to carry a poor prognosis, and treatment options for locally advanced disease remain limited. While systemic chemotherapy is the standard approach, local tumor control strategies such as RFA have been explored as potential adjuncts to improve survival outcomes. However, robust clinical evidence supporting their benefit has been lacking.
To address this, investigators conducted an international randomized clinical trial between April 2015 and December 2022, enrolling patients with unresectable LAPC who did not show disease progression after two months of induction chemotherapy. Participants were randomly assigned to receive either RFA in addition to continued chemotherapy or chemotherapy alone. The study included 188 patients, with a median age of 65 years, and a slight predominance of male participants.
Before randomization, most patients had received modified FOLFIRINOX regimens, while a smaller proportion were treated with gemcitabine-based therapies. The primary endpoint was overall survival, while secondary outcomes included progression-free survival, adverse events, and patient-reported quality of life assessed using validated cancer-specific questionnaires.
The trial revealed the following findings:
- No significant difference in overall survival was observed between the two groups after a median follow-up of 55 months.
- Median overall survival was 12.1 months in the RFA plus chemotherapy group versus 11.6 months in the chemotherapy-only group.
- Progression-free survival was comparable between the groups, with no significant benefit from adding RFA.
- The RFA group had a higher rate of serious (grade ≥3) adverse events.
- About 27% of patients in the RFA group experienced severe complications compared to 11% in the chemotherapy-only group.
- Patients undergoing RFA showed a clinically meaningful decline in quality of life.
- Global health status scores worsened over time in the RFA group.
- Quality-of-life measures remained relatively stable in patients receiving chemotherapy alone.
The findings suggest that incorporating RFA into the treatment strategy for LAPC after initial chemotherapy does not confer survival benefits and may instead increase treatment-related burden. The authors conclude that these results do not support the routine use of RFA in this patient population and highlight the importance of prioritizing therapies that balance efficacy with quality of life.
Reference:
Seelen LWF, Brada LJH, Walma MS, et al. Radiofrequency Ablation and Chemotherapy vs Chemotherapy Only in Locally Advanced Pancreatic Cancer: The PELICAN Randomized Clinical Trial. JAMA Netw Open. 2026;9(3):e263861. doi:10.1001/jamanetworkopen.2026.3861
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