Stage III pancreatic cancer and the role of irreversible electroporation

Abstract

About a third of patients with pancreatic cancer present with locally advanced disease that is not amenable to resection. Because these patients have localized disease, conventional ablative therapies (thermal ablation and cryoablation) have the potential to be beneficial, but their use is inherently limited in the pancreas. These limitations could be overcome by irreversible electroporation-a novel, non-thermal ablative method that is gaining popularity for the treatment of many soft tissue tumors, including those of the pancreas. This review summarizes the status of this technique in the treatment of locally advanced pancreatic cancer. Most of the evidence on efficacy and safety is based on non-randomized prospective series, which show that irreversible electroporation may improve overall survival and pain control in locally advanced pancreatic cancer. As experience with this procedure increases, randomized controlled trials are needed to document its efficacy in locally advanced pancreatic cancer more precisely.

Irreversible electroporation of locally recurrent pancreatic cancer with 5-year survival

“…Arrhythmias are contraindicated because the pulses are unable to be synchronized with the R-waves [9]. Metallic stents may conduct the electrical current and deflect the energy causing damage to surrounding structures or incomplete ablation [13]. Pre-operative removal of these stents is advisable.…”

Comparison of Survival Between Irreversible Electroporation Followed by Chemotherapy and Chemotherapy Alone for Locally Advanced Pancreatic Cancer

“…Induction chemotherapy of either FOLFIRINOX or GEMbased chemotherapy was used for a duration of 4 months (totaling 3 cycles of GEM-based chemotherapy or 4-6 cycles of FOLFIRINOX-based chemotherapy), which was in accordance with previous studies (12,13). The same line of chemotherapy was performed 7-14 days after IRE treatment.…”

Intraoperative Irreversible Electroporation in Locally Advanced Pancreatic Cancer: A Guide for the Interventional Radiologist

“…The safety of IRE in the pancreas has been demonstrated in multiple studies. 8,[19][20][21] An initial experience with IRE for LAPC demonstrated statistically significant improvements in local progression-free survival (PFS), distant PFS, and OS. 22 In the largest series of patients receiving pancreatic IRE for margin accentuation and in situ treatment for LAPC, Martin et al demonstrated a median OS of 24.9 months from the time of diagnosis, median local PFS of 10.7 months, and median distant PFS of 16.8 months.…”