Percutaneous CT-Guided Cryoablation for Pain Palliation and Local Treatment Effect in Unresectable Pancreatic Ductal...

Background/Objectives: Pain is one of the most disabling symptoms in patients with unresectable pancreatic ductal adenocarcinoma (PDAC), having a major impact on quality of life, functional status, and tolerance to oncologic treatment. Percutaneous computed tomography (CT)-guided cryoablation may provide tumor-directed pain palliation in selected patients. This study aimed to evaluate the safety and palliative clinical benefit of percutaneous CT-guided cryoablation in patients with painful unresectable PDAC. Methods: This retrospective single-center pilot case series included 11 consecutive patients with painful unresectable PDAC treated with percutaneous CT-guided cryoablation between January 2022 and May 2024. Primary endpoints were change in visual analogue scale (VAS) score and reduction in analgesic requirement. Secondary endpoints included technical success, adverse events, supportive clinical outcomes, imaging evolution, progression status, and survival. Results: Technical success was achieved in all procedures (11/11, 100%). No major procedure-related complications occurred; minor adverse events were observed in 3/11 patients (27.3%). Mean VAS score decreased from 6.72 ± 1.56 at baseline to 3.45 ± 1.44 at 1 month, 2.54 ± 1.29 at 3 months, 2.27 ± 1.43 at 6 months, and 1.60 ± 1.07 at 12 months. At 1 month, all patients showed a reduction of at least 3 VAS points. A reduction in analgesic requirement was documented in all patients during early follow-up, with complete opioid discontinuation in 5/11 patients (45.5%). At 1-month CT, residual enhancement was present in 9/11 patients (81.8%), although with an estimated 50-80% reduction in enhancing tumor burden. Observed survival proportions at 6 and 12 months were 90.9% and 72.7%, respectively. Conclusions: Percutaneous CT-guided cryoablation appears to be a feasible palliative option for selected patients with painful unresectable PDAC, with meaningful pain relief, opioid sparing, acceptable short-term safety, and exploratory imaging evidence of local cytoreductive effect. Further prospective studies are warranted.