Systematic Review of Irreversible Electroporation Role in Management of Locally Advanced Pancreatic Cancer

Abstract

Background: Ablative techniques provide in patients with locally advanced pancreatic cancer (LAPC) symptomatic relief, survival benefit and potential downsizing. Irreversible Electroporation (IRE) represents potentially an ideal solution as no thermal tissue damage occurs. The purpose of this review is to present an overview on safety, feasibility, oncological results, survival and quality of life improvement obtained by IRE. Methods: A systematic search was performed in PubMed, regarding the use of IRE on PC in humans for studies published in English up to March 2019. Results: 15 original studies embodying 691 patients with unresectable LAPC who underwent IRE were included. As emerged, IRE works better on tumour sizes between 3–4 cm. Oncological results are promising: median OS from diagnosis or treatment up to 27 months. Two groups investigated borderline resectable tumours treated with IRE before resection with margin attenuation, whereas IRE has proved to be effective in pain control. Conclusions: Electroporation is bringing new hopes in LAPC management. The first aim of IRE is to offer a palliative treatment. Further efforts are needed for patient selection, as well as the use of IRE for ‘margin accentuation’ during surgical resection. Even if promising, IRE needs to be validated in large, randomized, prospective series.

Antitumor Effect and Immune Response of Nanosecond Pulsed Electric Fields in Pancreatic Cancer

“…Pancreatic cancer is one of the most virulent malignancies, with a rapid progression, a low rate of resectability, and an extremely poor prognosis. It is estimated that the 5-year overall survival rate for patients with pancreatic cancer is only about 3% ( 1 ). Approximately 15–20% of patients have the chance of surgical resection at the beginning of diagnosis, but only 20% of these survive for 5 years ( 2 ).…”

The role of irreversible electroporation in promoting M1 macrophage polarization via regulating the HMGB1-RAGE-MAPK axis in pancreatic cancer

“…10 This is because 40% of PDAC patients were diagnosed of diseases major vascular involvement and another 40% were present with distant metastases. 11 For those with vascular involvement, which is also known as locally advanced pancreatic cancer (LAPC), chemotherapy is the recommended therapy, although it can only provide limited benefit for these patients. 12 Recently, irreversible electroporation (IRE) has emerged as a newly developed non-thermal ablative technology that produces an extremely high electric field across cells, inducing cell membrane disruption and tumor cell death.…”

Achieving ‘Marginal Gains’ to Optimise Outcomes in Resectable Pancreatic Cancer

“…Irreversible electroporation has gained interest, predominantly surrounding control of locally advanced pancreatic cancer though the technology could be applied to improve margin control at resectable cancer. However, concerns over safety and a lack of high level evidence remain [ 201 ]. There is thus much work to be done in this area and focussing efforts on the problem of the surgical margin could reduce local recurrence.…”