Background: Radiofrequency ablation (RFA) is an emerging treatment for patients with locally advanced pancreatic carcinoma (LAPC) and can be combined with radiochemotherapy (RCT), and intra-arterial plus systemic chemotherapy (IASC). Methods: This observational study compared two groups of patients with LAPC treated either with primary RFA (group 1) or RFA following primary treatment (group 2): systemic chemotherapy and/or RCT and/or IASC Group 1 included 47 patients submitted to RFA like up-front treatment; Group 2 included 60 patients submitted to RFA after other specified treatments. Results: Between February 2007 and May 2010, 107 consecutive patients were treated by RFA. There were 47 patients in group 1 and 60 in group 2. Median overall survival (OS) was 25.6 months, 14.7 months in Group 1 and 25.6 months in group 2 (p= 0.004) Patients treated with RFA, RCT and IASC (triple approach strategy) had an OS of 34.0 months. Conclusion: RFA after alternative primary treatment was associated with prolonged survival. This was further prolonged in selected patients using a triple approach strategy. Further evaluation of this approach seems warranted
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