Systematic Review of Surgical and Percutaneous Irreversible Electroporation in the Treatment of Locally Advanced Pancreatic Cancer

Moris, Demetrios; Machairas, Nikolaos; Tsilimigras, Diamantis I.; Prodromidou, Anastasia; Ejaz, Aslam; Weiss, Matthew J.; Hasemaki, Natasha; Felekouras, Evangelos; Pawlik, Timothy M.

doi:10.1245/s10434-019-07261-7

Cited by 52 publications

(44 citation statements)

References 43 publications

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“…51 A recent systematic review by Moris et al provides an elaborate overview of all studies that have utilized IRE for LAPC, with a median overall survival (OS) following IRE between 7 and 27 months ( Table 2). 44 This variance may pertain to selection bias, the utilized IRE approach, the diverse LAPC tumor biology (passive vs aggressive), personalized (neo-) adjuvant chemo-and/or radiotherapy protocols, performance status including comorbidities and other interpersonal patient differences. The additive value of IRE complementary to chemotherapy is becoming increasingly clear and neo-adjuvant chemotherapeutic treatment can be used as an effective way to select patients who are likely to benefit from ablation.…”

Section: Clinical Resultsmentioning

confidence: 99%

“…The average cumulative morbidity for surgical and percutaneous IRE was 36% vs 24%, with an average peri-procedural mortality rate of 2% vs 0%, respectively. 44 Most frequently encountered adverse events comprise GI-related complaints including pain, diarrhoea, nausea, vomiting, loss of appetite and delayed gastric emptying. The most severe complications include vessel occlusion, bleeding, severe pancreatitis, and death.…”

Section: Complicationsmentioning

confidence: 99%

“…Overview of open, laparoscopic and percutaneous pancreatic IRE studies and their survival outcomes (median, in months). Adapted from Moris et al 44…”

Section: Future Perspectivesmentioning

confidence: 99%

See 2 more Smart Citations

Irreversible Electroporation for Locally Advanced Pancreatic Cancer

Timmer¹,

Geboers²,

Ruarus

et al. 2020

Techniques in Vascular and Interventional Radiology

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Several minimally invasive image guided tumor ablation techniques have been added to the treatment spectrum for locally advanced pancreatic cancer (LAPC). Irreversible electroporation (IRE) might have a significant additive value in the management of this difficultto-treat disease. As opposed to thermal ablative techniques, IRE induces cell death by the delivery of highvoltage electrical pulses. The electrical energy disrupts the cellular membrane integrity, causes loss of cellular homeostasis and ultimately results in cell death. The extracellular matrix of connective tissue in surrounding delicate structures such as bile ducts, bowel wall, and larger blood vessels is spared. The preservation of these structures makes IRE attractive for the treatment of pancreatic cancers that are unresectable due to their anatomical location (ie, LAPC and local recurrence after surgical resection). In addition to its cytoreductive abilities, evidence is emerging on IRE's capability to induce systemic immunomodulation through active in vivo vaccination against pancreatic cancer cells. These effects in combination with immunotherapy may offer a new treatment paradigm for tumors with low immunogenic potential like pancreatic ductal adenocarcinoma (PDAC). This review discusses several practical and technical issues of IRE for LAPC: clinical evaluation, indications, patient preparations, procedural steps, imaging characteristics, clinical results, and "tricks of the trade" used to improve the safety and efficacy of the treatment. Future directions such as the combination of IRE with immunotherapy will be shortly addressed.

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Section: Clinical Resultsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

See 1 more Smart Citation

Irreversible Electroporation for Locally Advanced Pancreatic Cancer

Timmer¹,

Geboers²,

Ruarus

et al. 2020

Techniques in Vascular and Interventional Radiology

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show abstract

“…In a large systematic review, Moris et al reported that significant toxicities were more common following open or laparoscopic IRE and the percutaneous approach conveyed lower complication rates. 20 Complications of IRE, frequently classified according to the Clavien-Dindo classification system, have been described. Common low-grade complications include anorexia, dehydration, gastritis, nausea, vomiting, and pancreatitis.…”

Section: Cytoreduction Primary Tumormentioning

confidence: 99%

Ablative, Endovascular, and Biliary Interventions for Patients with Pancreatic Cancer

Hevert

Howser

Gould

et al. 2019

Semin intervent Radiol

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Interventional radiologists have multiple points of involvement in the treatment and management of patients with pancreatic adenocarcinoma. There is increasing interest in cytoreductive treatment of the primary tumor as well as metastatic disease via arterial and ablative techniques. The focus of this article is on the current evidence for pancreatic irreversible electroporation. For patients undergoing curative surgery or terminal palliation, interventional radiology can manage complications and symptoms. In this article, therapeutic and palliative options in this group of patients including postoperative embolization, biliary drainage, and stent placement are reviewed.

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“…0% 26. A recent systematic review of IRE for LAPC failed to show conclusive evidence for improved survival and raised concerns regarding treatment-related adverse events 27. Patient SelectionLAPC patients who cannot receive a standard resection and have shown durable response to neoadjuvant therapy, typically 4 to 12 months with or without radiation, may be candidates for IRE.…”

mentioning

confidence: 99%

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

Frey

Padula

Stauffer

et al. 2019

Semin intervent Radiol

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Efforts to improve mortality associated with locally advanced pancreatic cancer (LAPC) have shown minimal gains despite advances in surgical technique, systemic treatments, and radiation therapy. Locoregional therapy with ablation has not been routinely adopted due to the high risk of complications associated with thermal destruction of the pancreas. Irreversible electroporation (IRE) is an emerging, nonthermal, ablative technology that has demonstrated the ability to generate controlled ablation of LAPC while preserving pancreatic parenchymal integrity. IRE may be performed percutaneously or via laparotomy and will commonly involve multidisciplinary treatment teams. This article will describe the technical aspects of how multidisciplinary IRE is performed during laparotomy at a single tertiary care institution.

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Systematic Review of Surgical and Percutaneous Irreversible Electroporation in the Treatment of Locally Advanced Pancreatic Cancer

Cited by 52 publications

References 43 publications

Irreversible Electroporation for Locally Advanced Pancreatic Cancer

Irreversible Electroporation for Locally Advanced Pancreatic Cancer

Ablative, Endovascular, and Biliary Interventions for Patients with Pancreatic Cancer

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

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