Single-Institution Experience with Irreversible Electroporation for T4 Pancreatic Cancer: First 50 Patients

Kluger, Michael D.; Epelboym, Irene; Schrope, Beth; Mahendraraj, Krishnaraj; Hecht, Elizabeth M.; Susman, Jonathan; Weintraub, Joshua; Chabot, John A.

doi:10.1245/s10434-015-5034-x

Cited by 94 publications

(108 citation statements)

References 23 publications

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“…One treatment option for PDAC is IRE, which is an emerging, nonthermal, image-guided tumor ablation technique. IRE has been proven to be feasible and safe to locally advanced pancreatic cancer (LAPC), [3][4][5][6] and is approved in latest pancreatic cancer (PC) treatment guidelines.…”

Section: Introductionmentioning

confidence: 99%

Circulating Tumor DNA as a Sensitive Marker in Patients Undergoing Irreversible Electroporation for Pancreatic Cancer

Lin

Alnaggar

Liang

et al. 2018

Cell Physiol Biochem

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Background/Aims: Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed at an advanced stage, resulting in extremely poor 5-year survival. Late diagnosis of PDAC is mainly due to lack of a reliable method of early detection. Carbohydrate antigen (CA) 19-9 is often used as a tumor biomarker in PDAC; however, the test lacks sensitivity and specificity. Therefore, new sensitive and minimally invasive diagnostic tools are required to detect pancreatic cancer. Methods: Here, we investigated circulating tumor DNA (ctDNA) which contained KRAS-mutated as a potential diagnostic tool for PDAC patients who underwent irreversible electroporation (IRE). We used droplet digital polymerase chain reaction (ddPCR) to detect the expression of KRAS-mutated genes in plasma samples of 65 PDAC patients who underwent IRE. Results: In these 65 cases, ctDNA was detected in 20 (29.2%) samples. The median overall survival (OS) was 11.4 months with ctDNA+ patients and 14.3 months for ctDNA- patients. ctDNA+ patients had a obviously poorer prognosis associated to overall survival (P < 0.001). Conclusion: Our results suggested that the existence of ctDNA was a predictor of survival for PDAC patients. Therefore, ctDNA may be a new sensitive biomarker for monitoring treatment outcome in PDAC.

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Section: Introductionmentioning

confidence: 99%

Circulating Tumor DNA as a Sensitive Marker in Patients Undergoing Irreversible Electroporation for Pancreatic Cancer

Lin

Alnaggar

Liang

et al. 2018

Cell Physiol Biochem

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“…Kluger et al . [22] attributed the occurrence of portal or SMV thrombosis to the combination of hypercoagulability associated with pancreatic cancer, a low flow state from prior stenosis, as well as theoretical damage to the venous endothelium secondary to IRE. While the exact process and mechanism of thrombogenesis after IRE is still unknown, therapeutic post-IRE anticoagulation is nevertheless routinely recommended in the current protocols.…”

Section: Discussionmentioning

confidence: 99%

A Single-institution Experience with Open Irreversible Electroporation for Locally Advanced Pancreatic Carcinoma

Chen

et al. 2016

Chinese Medical Journal

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Background:Locally advanced pancreatic carcinoma (LAPC) is characterized by poor prognosis despite recommended concurrent chemoradiotherapy. Irreversible electroporation (IRE) has emerged as a potential option for the management of unresectable pancreatic cancer. This study was conducted to evaluate the safety and short-term efficacy of open IRE for the treatment of LAPC.Methods:Retrospective data of 25 consecutive patients receiving IRE for T3 lesions from July 2015 to June 2016 at a single center were analyzed. The perioperative and long-term IRE-related complications were reviewed to evaluate the safety of the procedure. The tumor reduction and biological response were analyzed through computed tomography/magnetic resonance imaging; the serum level of CA19-9 was measured as a secondary endpoint to evaluate the short-term efficacy of IRE.Results:All patients were successfully treated; the median tumor size was 4.2 cm and the median IRE time was 36 min. Four intraoperative procedure-related complications were observed (16%): two transient hypertensive episodes, one hypotension case, and one transient supraventricular tachycardia case. Nine postoperative complications were described, including three Grade A pancreatic fistulas, three delayed gastric emptying, one acute pancreatitis, one upper gastrointestinal hemorrhage, and one portal vein thrombosis. The overall rate of stable disease was 28%, 36% achieved partial response, and lower serum CA19-9 levels were recorded in all patients at discharge.Conclusions:IRE is feasible for the treatment of LAPC and is a reasonable intervention strategy owing to its combined attributes of safety and efficacy.

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“…Portal vein thrombosis is the most common vascular-associated complication of pancreatic cancer following RFA and IRE treatment (8,9,(42)(43)(44)(45)(46)(47)(48)(49)(50)(51). In related studies, patients with pancreatic cancer received RFA and IRE and the primary complications included acute pancreatitis (8,9,(42)(43)(44)(45)(46)48), abdominal pain (46,48), pancreatic fistula (8,9,42,43,45,49), duodenal ulcer or perforation (9,(42)(43)(44)49), gastrointestinal bleeding (42,(44)(45)(46)(47) and biliary fistula (46). In HIFU, the main complications included acute pancreatitis, skin burn, abdominal pain (22,33,34) and elevated amylase expression levels (14,21,33,34), whe...…”

Section: 12mentioning

confidence: 99%

Effects of high‑intensity focused ultrasound treatment on peripancreatic arterial and venous blood vessels in pancreatic cancer

et al. 2020

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The present study aimed to evaluate the safety of high-intensity focused ultrasound (HIFU) treatment on peripancreatic arterial and venous blood vessels in patients with pancreatic cancer. This trial included 15 patients with pancreatic cancer (9 females and 6 males; age, 39-81 years; median age, 62 years). All patients underwent preoperative computed tomography (CT) or magnetic resonance imaging (MRI) and color Doppler flow imaging (CDFI) to assess the vascular hemodynamics of peripancreatic arterial and venous blood vessels pre-treatment. These patients were re-examined within 1 week post-HIFU treatment. Then, vascular adverse events were observed and followed up clinically. Prior to HIFU treatment, vessel involvement was recorded in 13 patients, including tumor lesions invading 19 veins and 14 arteries, which refers to the growth of pancreatic tumor lesions surrounding blood vessels, or tumor growth into blood vessels. In addition, 9 veins and 13 arteries were <1 cm from the lesions. The hemodynamic parameters of peripancreatic vessels were measured using CDFI, including mean blood flow velocity, peak systolic blood flow velocity, vascular resistance index, vascular pulsatility index, vascular diameter, vascular blood flow and other indicators, to assess vascular perfusion in CT/MRI. There were no significant differences in preoperative and postoperative hemodynamic data (P>0.05). Overall, HIFU demonstrated no negative effects on peripancreatic arterial and venous blood vessels in patients with pancreatic cancer, even with tumor lesions wrapped in blood vessels. In addition, no complications of vascular stenosis and vascular adverse events were observed in the present study.

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Single-Institution Experience with Irreversible Electroporation for T4 Pancreatic Cancer: First 50 Patients

Cited by 94 publications

References 23 publications

Circulating Tumor DNA as a Sensitive Marker in Patients Undergoing Irreversible Electroporation for Pancreatic Cancer

Circulating Tumor DNA as a Sensitive Marker in Patients Undergoing Irreversible Electroporation for Pancreatic Cancer

A Single-institution Experience with Open Irreversible Electroporation for Locally Advanced Pancreatic Carcinoma

Effects of high‑intensity focused ultrasound treatment on peripancreatic arterial and venous blood vessels in pancreatic cancer

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