No abstract

Background/Aim: Irreversible electroporation (IRE) has recently been used as an experimental ablation treatment following systemic chemotherapy in locally advanced pancreatic cancer (LAPC). The primary aim of this study was to evaluate survival of LAPC patients after IRE prior to chemotherapy. The secondary aim was to examine the complication rates. Patients and Methods: Twenty-four patients with LAPC were included and treated with percutaneous ultrasound-guided IRE under general anesthesia. Survival data from the National Quality Registry for Pancreatic and Periampullary Cancer for LAPC during the same period were used for comparison. Results: The median survival after diagnosis was 13.3 months in the IRE group compared to 9.9 months in the registry group (p=0.511). Six patients had a severe complication after IRE treatment. Conclusion: No obvious gain in survival was observed with IRE as the first line treatment of LAPC and IRE was associated with severe complications. This study does not support percutaneous IRE in this setting.Locally advanced pancreatic cancer (LAPC) has a poor prognosis even with optimal standard treatment and it is the fourth leading cause of cancer-related deaths in the western world (1). The poor prognosis has led to several trials investigating new treatment modalities, including radiofrequency, microwave and cryoablation. Photodynamic therapy and high-intensity focused ultrasound have also been tried with minor improvements to the prognosis (2). In recent years, several studies have been published about the use of irreversible electroporation (IRE) in LAPC, mostly following treatment with chemotherapy (1, 3-5). However, Belfiore et al. have presented data on IRE followed by chemotherapy in 20 patients with LAPC and were able to perform R 0 resections on three patients (6). Our study represents our experience with IRE prior to chemotherapy in LAPC patients. The primary aim was to investigate overall survival and the secondary aim was to examine the rate of complications in this setting. Patients and MethodsPatients. Patients included in our study had biopsy-proven LAPC defined as superior mesenteric-or celiac-artery encasement, aortic invasion or unreconstructable superior mesenteric-or portal-vein involvement, with no evidence of metastatic disease on abdominal and thoracic computed tomography (7) or at laparotomy, and no prior systemic treatment. Exclusion criteria were age <18, implanted electronic devices, ASA score IV, expected survival <3 months, pregnancy, epilepsy, severe heart disease, and tumor diameter >5 cm. All patients signed a consent form before treatment. Prior to inclusion, all patients were discussed at a multi-disciplinary team conference. Following IRE, starting adjuvant chemotherapy was recommended.Twenty-five patients were considered a sufficient number to allow for preliminary conclusions on survival and complications. In the case of computed tomography (CT) evaluated response to the IRE treatment, indicating that R 0 resection could be achieved, resection would ...