Radiofrequency ablation (RFA) for pancreatic cancer has been studied in locally advanced disease that cannot be removed by surgery, in the hope that destroying part of the tumor with heat might help patients live longer. The PELICAN randomized trial, published in JAMA Network Open in 2026, tested this directly.
The short answer: in patients whose cancer had not progressed after two months of chemotherapy, adding RFA to chemotherapy did not lengthen overall survival (median 12.1 vs 11.6 months), while serious adverse events and loss of quality of life were greater with RFA.
Study stage · Results paper of a completed international multicenter randomized trial (ClinicalTrials.gov NCT03690323). RFA of the pancreas was given as an experimental treatment within the trial, not as an approved standard. This article summarizes the paper for patients; it does not recommend for or against any treatment.
The PELICAN trial: what question did it ask?
Locally advanced pancreatic cancer means the tumor surrounds major blood vessels, so it cannot be removed right away, but it has not spread to distant organs. Chemotherapy is the core of treatment, and only some patients become candidates for surgery afterwards.
Earlier observational (cohort) studies reported survival of 26–34 months in patients treated with chemotherapy plus RFA. Such studies may include fitter, selected patients, so it was unclear whether RFA itself made the difference. The Dutch Pancreatic Cancer Group therefore designed PELICAN, which assigned patients by chance.
- Question: does adding RFA to chemotherapy lengthen overall survival in non-progressing locally advanced pancreatic cancer?
- Period: enrolment April 2015 to December 2022; median follow-up 55 months
- Primary endpoint: overall survival; secondary endpoints included progression-free survival, adverse events and quality of life
Who took part?
Adults with unresectable locally advanced pancreatic cancer who had at least stable disease on CT after about two months of induction chemotherapy. An expert panel reviewed unresectability and technical feasibility of RFA.
188 patients were randomized (95 to RFA plus chemotherapy, 93 to chemotherapy alone); median age 65 years, 53% men. Most received modified FOLFIRINOX induction (85% and 86%); the rest a gemcitabine-based regimen. The protocol planned 228 patients.
How RFA was done matters · According to the trial protocol, RFA was not a needle procedure through the skin. It was performed during open abdominal surgery (laparotomy) under ultrasound guidance with bipolar probes. The aim was maximal tumor reduction while keeping a safety zone around vessels and the duodenum, followed by resumed chemotherapy.
Results: survival, progression and side effects
| Outcome | RFA + chemo (95) | Chemo only (93) | Comparison |
|---|---|---|---|
| Median overall survival | 12.1 mo (95% CI 9.9–14.3) | 11.6 mo (95% CI 9.4–13.9) | HR 1.07 (95% CI 0.80–1.45), P=.64 |
| Median progression-free survival | 5.8 mo (95% CI 4.4–7.2) | 6.9 mo (95% CI 5.3–8.5) | P=.47 |
| Grade ≥3 serious adverse events | 26 (27%) | 10 (11%) | P=.004 |
| Change in global health status | -14.6, -12.0, -18.4 at 1, 3, 18 months | Below the 10-point relevance threshold | EORTC QLQ-C30 |
Comparator: patients who continued chemotherapy alone during the same period. Figures from the abstract of Seelen LWF et al., JAMA Netw Open 2026;9(3):e263861.
The 0.5-month difference in median survival is not meaningful given a hazard ratio of 1.07 and a confidence interval of 0.80–1.45. Progression-free survival was numerically higher in the control group, but again not significantly. Serious adverse events were about 2.5 times as common with RFA, and only the RFA group had a clinically relevant (10+ point) drop in quality of life. The authors concluded that RFA did not improve survival and harmed quality of life.
How to read these results: limits and interpretation
- It tested open RFA. Other local treatments such as endoscopic ultrasound-guided RFA (EUS-RFA) or irreversible electroporation (IRE, NanoKnife) were not tested, so this paper alone cannot judge them.
- A narrow group. Only patients without progression after two months of chemotherapy were included.
- Cohort numbers vs randomized numbers. The 26–34 months seen in older cohorts may reflect patient selection; in this randomized trial both groups were around 12 months.
- Fewer patients than planned. 188 of a planned 228. Even so, the upper confidence limit (1.45) and the side-effect gap make a benefit unlikely, in the authors' view.
Can you get pancreatic RFA in Japan or abroad?
PELICAN was planned with 16 centers in the Netherlands and other European centers, and RFA was given only inside the trial. These results do not support adding open RFA to standard chemotherapy for locally advanced pancreatic cancer.
Some hospitals in Japan, the US and Europe describe heat- or electricity-based local treatment of pancreatic tumors as research or as self-funded care. If you consult them, first ask whether the treatment is an approved standard, a registered clinical trial, or a hospital's own self-pay service, and ask for the original evidence. Results in organs where RFA is established (liver, kidney, lung) should not be assumed for the pancreas. For basics, see our RFA guide and IVR guide.
What to check and questions for your doctor
- Is my cancer locally advanced (unresectable) or borderline resectable? Will surgery be reassessed after chemotherapy?
- Which local treatment is proposed (open RFA, EUS-RFA, IRE), and are there randomized results for that exact method?
- Is it approved care, a clinical trial (registration number) or self-pay care? What are the costs and responsibilities?
- What serious complications (pancreatitis, bleeding, duodenal injury) are expected and how often? How long would chemotherapy be delayed?
- What can be included in the plan for quality of life and pain control?
Update, October 2026 · For the US DIRECT registry (The Oncologist 2026), in which stage III patients whose treatment added NanoKnife irreversible electroporation after chemotherapy had a median survival of 28 months from diagnosis, see NanoKnife (IRE) for pancreatic cancer: DIRECT survival results.
Related: for preparation, the day of the procedure and recovery after radiofrequency ablation, see liver cancer RFA procedure steps and recovery time. For a phase 3 trial in which adding RFA after TACE improved survival in liver cancer, see TACE plus RFA for intermediate-stage liver cancer: the TORCH trial. For one-year results of thermal ablation for liver metastases from colorectal cancer, see microwave ablation for colorectal liver metastases: one-year results in 491 European patients. A US comparison of the same radiofrequency ablation in thyroid nodules is in thyroid nodule RFA vs microwave ablation.
See also five questions before an RFA consultation and how to check a study's stage.
Frequently asked questions
Does this mean RFA does not work for pancreatic cancer?
PELICAN showed that adding open RFA to chemotherapy did not lengthen overall survival in locally advanced pancreatic cancer that had not progressed after two months of chemotherapy. It does not settle other methods or other patient groups, but in this setting no benefit was found and side effects were more common.
How common are side effects after RFA?
Grade 3 or higher serious adverse events occurred in 27% (26) of the RFA group and 11% (10) of the chemotherapy-only group. RFA was done with open surgery, so figures may differ for other approaches.
Earlier studies reported survival of more than two years. Why the difference?
Cohort studies reported 26–34 months, but they may have included selected, fitter patients. In the randomized PELICAN trial, median survival was 12.1 months with RFA and 11.6 months without.
Can I receive pancreatic RFA in Japan?
It depends on the institution. Before treatment, confirm whether it is approved care, a clinical trial or self-pay care, and ask for the supporting papers. This trial gives no basis to add RFA to standard treatment.
This article is general information summarizing a published paper, not medical advice. Discuss treatment choices with the doctors who examine you.
Sources
- Seelen LWF, …, Molenaar IQ; Dutch Pancreatic Cancer Group. Radiofrequency Ablation and Chemotherapy vs Chemotherapy Only in Locally Advanced Pancreatic Cancer: The PELICAN Randomized Clinical Trial. JAMA Netw Open. 2026;9(3):e263861.
- University research pages for the same paper: UMC Utrecht, Amsterdam UMC.
- Walma MS et al. PELICAN study protocol. Trials. 2021;22:313.
- Trial registration: ClinicalTrials.gov NCT03690323.
Need an overseas paper read accurately?
FTH translates overseas IVR and RFA papers and medical records, including study stage and limitations, and supports interpretation for consultations abroad.