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Endoscopic Ultrasound-guided RadioFrequency Ablation for the Treatment Pancreatic NeuroEndocrine Neoplasms


2019-09-01


2024-01-01


2024-02-01


60

Study Overview

Endoscopic Ultrasound-guided RadioFrequency Ablation for the Treatment Pancreatic NeuroEndocrine Neoplasms

This study evaluates the possibility and the safety of performing local therapy for Pancreatic neuroendocrine neoplasms (PanNENs) using radiofrequency ablation of the tumor under ultrasonography (EUS) guidance.

Pancreatic neuroendocrine neoplasms (PanNENs) are rare, but their incidence has significantly increased in the last decades. The mainstay treatment of PanNENs is surgery, which is associated with a significant benefit in term of survival but also with significant short- and long-term adverse events. Based on the above data, less invasive alternative therapeutic interventions to avoid short- and long-term adverse events of surgery are needed. In this context radiofrequency ablation has been reported to be effective in the treatment of these tumors in absence of major adverse events. However, the available studies on the matter are limited by small sample size and lack of standardized criteria for patient selection.

  • Neuroendocrine Tumors
  • Neuroendocrine Carcinoma
  • Pancreas Neoplasm
  • Neuroendocrine Tumor Gastrointestinal, Hormone-Secreting
  • DEVICE: EUS guided radiofrequency ablation
  • RAPNEN

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates Results Reporting Dates Study Record Updates

2019-02-04  

N/A  

2024-02-12  

2019-02-06  

N/A  

2024-02-13  

2019-02-08  

N/A  

2024-02  

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

Design Details

Primary Purpose:
Treatment


Allocation:
Na


Interventional Model:
Single Group


Masking:
None


Arms and Interventions

Participant Group/ArmIntervention/Treatment
EXPERIMENTAL: EUS guided radiofrequency ablation

Radiofrequency ablation will be performed using a system that consists of an 19-gauge needle electrode (140-cm long), a radiofrequency generator, and an inner cooling system that circulates chilled saline solution during the RFA procedure.

DEVICE: EUS guided radiofrequency ablation

  • The EUS-RFA system (Taewoong, Seoul, Korea) utilized for EUS-RFA consists of an 19-gauge needle electrode (140-cm long), a radiofrequency generator, and an inner cooling system that circulates chilled saline solution during the RFA procedure. The inner me
Primary Outcome MeasuresMeasure DescriptionTime Frame
Incidence of adverse events (AEs) after EUS-guided radiofrequency ablation (RFA)AEs will be classified as procedural when they occur during the procedure; post-procedural when they will occur up to 14 days after the procedure; late when they will occur more than 14 days after the procedure. Minor AEs will be those that need no therapy and have no sequelae (A) or have minor therapy or consequence, including overnight admission (B). Major events include those that require major therapy or hospitalization (24- 48 hours) (C); major therapy, need unplanned increase in level of care, or hospitalization >48 hours (D); or result in permanent adverse sequelae (E) and death (F).1 year
Secondary Outcome MeasuresMeasure DescriptionTime Frame
Rates of secondary surgeryNumber of patients who will require secondary surgey due to adverse events occurence, no response/failed or partial/recurrence outcome to the RFA treatment1 year

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person’s general health condition or prior treatments.

Ages Eligible for Study:
ALL

Sexes Eligible for Study:
18 Years

Accepts Healthy Volunteers:

    Inclusion Criteria:
    For all patients

  • Age ≥18 years and <80 years
  • Signed written informed consent
  • Distance from the main pancreatic duct ≥2mm
  • Able to undergo endoscopic ultrasound examination
  • Homogeneous enhancement at contrast harmonic EUS (CH-EUS)

  • For patients with functional pancreatic neuroendocrine neoplasms (F-PanNENs), almost all insulinomas

  • Definitive diagnosis of a clinical syndrome related to excessive insulin secretion fasting test, insulin blood levels, C-peptide blood levels)
  • Single lesion visualized at CT, and/or MRI, and/or EUS
  • Size < 20mm

  • For patients with non functional pancreatic neuroendocrine neoplasms (NF-PanNENs)

  • EUS fine needle biopsy (FNB) proven NF-PanNENs
  • 68Ga-DOTATATE PET/CT positive for a pancreatic lesion and negative for lymph nodes, liver, and other distant metastases
  • Hyper- or Iso-enhancing pattern at MRI and/or CT with negative lymph nodes, liver, and other distant metastases
  • G1 or G2 ≤ 5% on histological examination of EUS-guided biopsy samples utilizing EUS-FNB needles
  • Diameter between 15mm and 25mm,
  • Absence of symptoms
  • Absence of inner calcifications

  • Exclusion Criteria:

  • For all patients
  • Known bleeding disorder that cannot be sufficiently corrected with co-fact or fresh frozen plasma (FFP)
  • Use of anticoagulants that cannot be discontinued
  • INR >1.5 or platelet count <50.000
  • Previous inclusion in other studies
  • Pregnancy
  • Minimal distance from the main pancreatic duct <1mm
  • Inability to sign the informed consent
  • Heterogeneous enhancement at contrast harmonic EUS (CH-EUS)

  • For patients with F-PanNENs (almost all insulinomas)

  • Diagnosis work up negative excessive hormone secretion syndrome
  • Multiple lesions visualized at CT, and/or MRI, and/or EUS
  • Size > 20mm
  • For patients with NF-PanNENs
  • G2>5% or G3 on histological examination of EUS-guided biopsy samples
  • Diameter <15 mm and >25 mm
  • Presence of symptoms
  • Presence of calcifications
  • Hypo-enhancing pattern at MRI and/or CT
  • 68Ga-DOTATATE PET/CT positive for lymph nodes, liver, and other distant metastasis
  • Diagnosis on multiple endocrine neoplasia type 1 (MEN1) syndrome or Von Hippel Lindau syndrome
  • Previous inclusion in other studies

Collaborators and Investigators

This is where you will find people and organizations involved with this study.


    • PRINCIPAL_INVESTIGATOR: Alberto Larghi, PhD, Fondazione Policlinico Universitario Agostino Gemelli

    Publications

    The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

    General Publications

    • Hofland J, de Herder WW, Kann PH. Turning Up the Heat: Endoscopic Ablation of Pancreatic Neuroendocrine Neoplasms. J Clin Endocrinol Metab. 2019 Nov 1;104(11):5053-5055. doi: 10.1210/jc.2019-00954. No abstract available.