## 1 Introduction  
Pancreatic adenocarcinoma (PDAC) is one of the most lethal forms of cancer, defined by a poor prognosis, with limited treatment options and a lack of responsiveness to chemotherapy. Despite advances in surgical techniques and chemotherapy, the five-year survival rate for pancreatic cancer barely exceeds 10% [1]. The majority of patients are diagnosed at an advanced stage when the tumor is unresectable, underscoring the need to explore the field of alternative therapeutic approaches [2]. Recently, endoscopic ultrasound (EUS) has evolved from its role as a diagnostic tool into an important therapeutic alternative for pancreaticobiliary diseases, especially when endoscopic retrograde cholangiocarcinoma-reatography (ERCP) fails [3]. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has emerged as a promising minimally invasive therapy for use in pancreatic masses, after consistent reports of high efficacy and a good safety profile in neuroendocrine pancreatic tumors and pancreatic cystic lesions [4; 5]. The initial experience with this technique in pig models showed promising results in terms of both safety and efficacy, allowing for precise targeting of the tumor while sparing surrounding healthy tissues [6; 7; 8; 9; 10]. In the early stages of using RFA for PDAC, most of the procedures were performed intraoperatively or percutaneousally, with inconclusive results and significant morbidity [11; 12; 13; 14; 15; 16]. The feasibility and safety profile of RFA for locally advanced pancreatic cancer using a surgical approach have been reported since 2010 [17; 18]. These approaches often exhibited limitations due to local complications (biliary and pancreatic fistula, acute pancreatitis) and the technical difficulties of targeting tumors. Moreover, in a randomized controlled study, intraoperative RFA did not show any benefits in terms of overall survival (OS) and progression-free survival (PFS) when compared to conventional chemoradiotherapy in locally advanced PDAC [19]. However, the development of endoscopic ultrasound-guided RFA (EUS-RFA) has gradually shifted the perspective on this technique by providing real-time and precise targeting of pancreatic lesions, which enhanced the efficacy of tumor ablation while minimizing the damage to adjacent tissues and the risk of severe complications [20]. These findings have paved the way for EUS-RFA to become a more reliable tool in the management of PDAC. The mechanisms through which EUS-RFA could potentially improve outcomes in pancreatic cancer patients are mostly related to tumor downstaging through coagulative necrosis and reduction in tumor mass [14]. Moreover, the disruption of tumor vasculature and the anti-angiogenic effect of thermal injury are also cited as mechanisms to control tumor microenvironments [12]. In addition to its contribution to reducing tumor burden via its cytoreductive effect, it appears that RFA also has an anti-cancer effect induced through immunomodulatory activity [21]. It is well recognized that the immunosuppressive nature and dense stroma of the PDAC tumor microenvironment contribute to its dismal prognosis by acting as a barrier to chemotherapeutic agents [22]. By disrupting the tumor microenvironment, local therapies have been theorized to potentially enhance the penetration of antinumoral treatments in PDAC [23; 24; 22]. Moreover, antigen exposure after RFA promotes immune activation and enhances immune response in tumor lesions distant from the targeted site, known as the abscopal effect. In a murine model, [PERSON] et al. showed that RFA can induce remodeling of the tumor microenvironment and increase antimuromal immunity, thus creating a window for the role of immunotherapy in PDAC [25]. This review aims to provide a comprehensive analysis of the current literature on EUS-RFA for pancreatic adenocarcinoma, focusing on key outcome measures such as technical success rate, adverse events, tumor response, and patient survival.