## 3 Results
### Efficacy Analysis  
[PERSON] et al. [26] monitored tumor volume changes in patients undergoing EUS-RFA using CT scans. Of the 16 patients, only 6 displayed sufficient quality imaging to assess volume changes, and these patients were evaluated at two separate time points: once between 0 and 37 days post-ablation and again between 12 and 76 days. The results indicated a continuous reduction in tumor size over time. The median postoperative survival for 13 of the 16 patients who completed follow-up was 6 months. Another study, conducted by [PERSON] et al. [32], analyzed overall survival (OS) and progression-free survival (PFS) in patients treated with EUS-RFA. The authors identified the time from tumor diagnosis to EUS-RFA and the tumor's extent as negative impact factors on both OS and PFS. Additionally, they noted a marginally significant correlation between the number of EUS-RFA sessions and PFS (\(p\) = 0.051). The median OS and PFS in this study were superior to those previously reported in similar patient populations, suggesting that EUS-RFA may have a positive influence on these outcomes.  
Furthermore, [PERSON] et al. [31] proposed a different approach using EUS-RFA at a lower ablation power combined with multiple sessions. In their study, the efficacy outcomes included tumor size reduction, serum CA 19-9 levels, MRI diffusion-weighted imaging (DWI) apparent diffusion coefficient (ADC) values, and the percentage of the tumor area ablated one month after treatment. Two patients exhibited tumor size reduction, while five patients showed a decrease in serum CA 19-9 levels. One patient, who survived over 12 months, showed an increase in ADC values and a 20% ablated area, suggesting that EUS-RFA may contribute to prolonged survival. However, the overall survival rate in this cohort did not show a clear benefit from the procedure.  
Similarly, [PERSON] et al. [33] performed EUS-RFA in 10 patients with unresectable pancreatic cancer, 7 with locally advanced pancreatic cancer (LAPC), and 3 with metastatic disease. The secondary endpoints included OS and serum CA 19-9 response. A total of 7 out of 10 patients with elevated pre-treatment CA 19-9 levels demonstrated significant reductions in serum CA 19-9 following the procedure. Follow-up imaging was available for nine patients, showing stable disease in two patients and tumor regression in seven, with a greater than 50% tumor size reduction in three cases. The median survival was 20.5 months, while post-RFA survival reached 13.4 months.  
In the only randomized study, [PERSON] et al. [34] explored the potential benefit of adding EUS-RFA to standard chemotherapy for advanced pancreatic cancer. Although no significant differences in survival were found between the groups, patients treated with EUS-RFA exhibited tumor necrosis in 100% of cases, according to imaging, and required lower doses of pain medication. [PERSON] et al. [36] also showed an improvement in oncological outcomes following EUS-RFA in advanced pancreatic cancer patients. They found a significant reduction in tumor size, with a greater than 50% diameter reduction in 5 of 11 patients. Additionally, the Eastern Cooperative Oncology Group (ECOG) score improved in all surviving patients, further suggesting that EUS-RFA may benefit patients with advanced disease.  
Recently, [PERSON] et al. [37] proposed a novel protocol for resectable PDAC, consisting of neoadjuvant chemotherapy and EUS-RFA, followed by surgery after a 4-week treatment break and then continuing with adjuvant chemotherapy. No anastomotic leak was observed after pancreaticoduodenectomy, all with R0 resections, in the three patients recruited. Also, there was no recurrence after a median of 13 months of follow-up.