The efficacy of combination of induction chemotherapy and irreversible electroporation ablation for patients with locally advanced pancreatic adenocarcinoma

Huang, Kai‐Wen; Yang, P. C.; Pua, Uei; Kim, Man Deuk; Li, Sheng Ping; Qiu, Yu; Song, Tongtong; Liang, Po-Chin

doi:10.1002/jso.25110

Cited by 31 publications

(27 citation statements)

References 15 publications

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“…The median OS was 16 and 21.6 months for patients after IRE combined with chemotherapy in the SEER and SYSUCC datasets, respectively. The median OS was similar to that from a study conducted by Huang et al (26) and was significantly higher than that of patients after chemotherapy alone (8.0 months for the SEER patients and 7.1 months for the SYSUCC patients). In addition, the SEER patients had a long follow-up period, and it was shown that combination therapy was superior to chemotherapy alone with respect to not only 5-year OS rates but also 5-year CSS rates for all enrolled patients even though larger proportions of patients in the chemotherapy group received radiotherapy.…”

Section: Discussionsupporting

confidence: 83%

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

Huang

Cai

et al. 2020

Front. Oncol.

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Locally advanced pancreatic cancer (LAPC) has a dismal prognosis even after standard chemotherapy, and local progression contributes to nearly one-third of the deaths of these patients. As a local destructive method, irreversible electroporation (IRE) can feasibly treat LAPC. The aim of this study was to evaluate IRE combined with chemotherapy as a new treatment and compare its efficacy with that of chemotherapy alone in patients with LAPC. The data of LAPC patients who received chemotherapy with or without IRE were extracted from Surveillance, Epidemiology, and End Results (SEER) database and medical records of Sun Yat-sen University Cancer Center (SYSUCC). The efficacy of these two treatments was compared using propensity score matching (PSM) analysis. LAPC patients treated with the combination therapy had better overall survival (OS). Significantly higher cancer-specific survival (CSS) and progression-free survival (PFS) rates were also observed in patients after IRE combined with chemotherapy, compared with chemotherapy alone. IRE combined with chemotherapy was established as a favorable factor for OS, CSS, and PFS in LAPC patients. This combination method may be a more suitable treatment for patients with LAPC.

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Section: Discussionsupporting

confidence: 83%

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

Huang

Cai

et al. 2020

Front. Oncol.

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“…The safety and effectiveness of IRE have been reported by many previous studies [14, 29]. Moreover, it was illustrated that IRE was reasonably safe in LAPC after chemotherapy and with promising results regarding efficacy [17, 30]. Although it was shown that the subsequent IRE or radiotherapy after chemotherapy might result in improved survival compared with chemotherapy alone, there was no direct data illustrating the comparison of efficacy of these two local control treatments after the induction chemotherapy in patients with LAPC.…”

Section: Discussionmentioning

confidence: 91%

Irreversible electroporation versus radiotherapy after induction chemotherapy on survival in patients with locally advanced pancreatic cancer: a propensity score analysis

Wang

Sun

et al. 2019

BMC Cancer

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Background Locally advanced pancreatic cancer (LAPC) represents more than one third of pancreatic cancers and owns poor survival after the standard chemotherapy. Irreversible electroporation (IRE) is a novel method and has been recently used in LAPC. The aim of this study was to compare the efficacy of IRE and radiotherapy after induction chemotherapy for patients with LAPC. Methods From August 2015 to August 2017, a total of 76 patients with biopsy proven LAPC and who had received IRE or radiotherapy after chemotherapy were included. Thirty-two pairs of patients were selected through propensity score matching (PSM) analysis and the efficacy of two treatments was compared. Results Before PSM analysis, after induction chemotherapy, patients with LAPC benefited more in terms of overall survival (OS) and progression free survival (PFS) from IRE, compared with radiotherapy (2-year OS rates, 53.5% vs 26.9%, p = 0.039; 2-year PFS rates, 28.4% vs 13.3%, p = 0.045). After PSM analysis, the survival benefits of OS and PFS of patients after induction chemotherapy followed by IRE were more obvious than those of patients treated with radiotherapy (2-year OS rates, 53.5% vs 20.7%, p = 0.011; 2-year PFS rates, 28.4% vs 5.6%, p = 0.004). Multivariate Cox regression analysis indicated that IRE after induction chemotherapy was identified as a significant favourable factor for both OS and PFS in both the whole and matched cohort. Conclusions Induction chemotherapy followed by IRE is superior to induction chemotherapy followed by radiotherapy for treating LAPC. A randomized clinical trial comparing the efficacy of IRE and radiotherapy after the induction chemotherapy is therefore considerable.

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“…To date, increasing evidence from the literature suggests that IRE in combination with neo-adjuvant chemotherapy and/or radiotherapy elicits a survival benefit for this set of patients, confirming safety and efficacy of the procedure. 5,7,16,[48][49][50] Moreover, IRE treatment has been found to not adversely affect quality of life in the short term. 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).…”

Section: Clinical Resultsmentioning

confidence: 99%

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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The efficacy of combination of induction chemotherapy and irreversible electroporation ablation for patients with locally advanced pancreatic adenocarcinoma

Abstract: Our study suggests that IRE is safe and effective for the control of LAPC. We surmise that the addition of IRE to a chemotherapy regimen may provide a survival advantage.

Cited by 31 publications

References 15 publications

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

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

Irreversible electroporation versus radiotherapy after induction chemotherapy on survival in patients with locally advanced pancreatic cancer: a propensity score analysis

Irreversible Electroporation for Locally Advanced Pancreatic Cancer

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