Treatment of locally advanced pancreatic cancer with irreversible electroporation – a Danish single center study of safety and feasibility

Flak, Rasmus Virenfeldt; Stender, Mogens Tornby; Jensen, Tonny; Andersen, Karen V; Henriksen, Stine Dam; Mortensen, P.B.; Sall, Mogens; Thorlacius-Ussing, Ole

doi:10.1080/00365521.2019.1575465

Cited by 23 publications

(30 citation statements)

References 26 publications

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“…In addition, timing of IRE varied because the time of referral varied greatly, and no strict policy was implemented regarding pretreatment strategies and timing of IRE after these treatments. The upper size limit of 5 cm may have introduced a confounder for the comparison of survival data to data from systemic regimens or other local treatments because a larger tumor was associated with worse survival (18,27). Moreover, diagnostic laparoscopy was not performed routinely.…”

Section: Survivalmentioning

confidence: 99%

Percutaneous Irreversible Electroporation in Locally Advanced and Recurrent Pancreatic Cancer (PANFIRE-2): A Multicenter, Prospective, Single-Arm, Phase II Study

Ruarus¹,

Vroomen²,

Geboers³

et al. 2020

Radiology

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P ancreatic adenocarcinoma is the fourth leading cause of cancer death in the United States (1). The 5-year relative survival of patients with pancreatic cancer is less than 8% (1). Contributing to the dismal survival rate is that most patients are diagnosed with advanced disease because of lack of symptoms at early stage pancreatic cancer (1). Surgical resection with adjuvant chemotherapy is considered the best treatment option for long-term survival. However, fewer than 20% of patients present with resectable disease, and, even in this subset of patients, median overall survival (OS) after successful resection and adjuvant therapy is only 28 months (2). Furthermore, one-third of patients develop isolated local recurrence after resection (3), which is commonly unresectable because of vascular involvement (4).Approximately 30% of patients present with locally advanced pancreatic cancer (American Joint Committee on Cancer stage III), defined as greater than 180° circumference tumor encasement of the superior mesenteric or celiac

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Section: Survivalmentioning

confidence: 99%

Percutaneous Irreversible Electroporation in Locally Advanced and Recurrent Pancreatic Cancer (PANFIRE-2): A Multicenter, Prospective, Single-Arm, Phase II Study

Ruarus¹,

Vroomen²,

Geboers³

et al. 2020

Radiology

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“…CT-guided IRE requires administration of intravenous contrast to best visualize the tumor and its relationship to adjacent major vessels. US-guided percutaneous IRE has been reported[ 58 - 60 ] and US-guidance may be feasible in patients with low body mass index and without overlying gas-filled stomach and bowel loops, but in most patients percutaneous US is not suitable to guide pancreatic IRE ablation. The percutaneous approach is less invasive, and the hospital stay is shorter compared to open IRE, however, the management of procedural bleeding complications can be challenging and there are limitations to detect peritoneal and nodal metastases.…”

Section: Minimally Invasive Treatments Of Lapcmentioning

confidence: 99%

Minimally invasive image-guided therapy of primary and metastatic pancreatic cancer

Bibok

Kim

Malafa

et al. 2021

WJG

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Pancreatic cancer is a challenging malignancy with limited treatment options and poor life expectancy. The only curative option is surgical resection, but only 15%-20% of patients are resectable at presentation because more than 50% of patients has distant metastasis at diagnosis and the rest of them has locally advanced pancreatic cancer (LAPC). The standard of care first line treatment for LAPC patients is chemotherapy with or without radiation therapy. Recent developments in minimally invasive ablative techniques may add to the treatment armamentarium of LAPC. There are increasing number of studies evaluating these novel ablative techniques, including radiofrequency ablation, microwave ablation, cryoablation and irreversible electroporation. Most studies which included pancreatic tumor ablation, demonstrated improved overall survival in LAPC patients. However, the exact protocols are yet to set up to which stage of the treatment algorithm ablative techniques can be added and in what kind of treatment combinations. Patients with metastatic pancreatic cancer has dismal prognosis with 5-year survival is only 3%. The most common metastatic site is the liver as 90% of pancreatic cancer patients develop liver metastasis. Chemotherapy is the primary treatment option for patients with metastatic pancreatic cancer. However, when the tumor is not responding to chemotherapy or severe drug toxicity develops, locoregional liver-directed therapies can provide an opportunity to control intrahepatic disease progression and improve survival in selected patients. During the last decade new therapeutic options arose with the advancement of minimally invasive technologies to treat pancreatic cancer patients. These new therapies have been a topic of increasing interest due to the severe prognostic implications of locally advanced and metastatic pancreatic cancer and the low comorbid risk of these procedures. This review summarizes new ablative options for patients with LAPC and percutaneous liver-directed therapies for patients with liver-dominant metastatic disease.

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“…The optimal outcome following successful neoadjuvant treatment is downstaging to borderline-resectable disease or even resectable disease for surgical conversion. 17,18 Only 12 to 35% of LAPC patients are eligible for conversion surgery following neoadjuvant treatment. 19,20 The role of neoadjuvant therapy has been studied extensively.…”

Section: Surgerymentioning

confidence: 99%

Emerging Ablative and Transarterial Therapies for Pancreatic Cancer

Narayanan

Ucar

Gandhi

et al. 2020

Digestive Disease Interventions

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Pancreatic adenocarcinoma is a highly aggressive malignancy with a poor prognosis secondary to late presentation with metastases, challenging resection, and limited alternative therapies. Standard treatment strategies for pancreatic cancer include surgery, chemotherapy, and radiation therapy. These options can extend survival and/or relieve symptoms but are seldom curative. Thermal ablative therapies have been utilized in pancreatic cancer mostly in an open surgical setting. Irreversible electroporation (IRE) is a nonthermal ablative option for pancreatic cancer that uses high voltage, low energy direct current to induce cell death. IRE technology has been shown to spare critical structures such as blood vessels and bile ducts. The safety and efficacy of the percutaneous IRE in Stage 3 pancreas cancer has been studied and there is currently a Food and Drug Administration approved, randomized, controlled trial, and registry enrolling patients in the United States. Recent animal studies have also demonstrated that the advantages of IRE may extend beyond the local tumor effect. In addition to this local ablative option, a phase 3 trial is studying a transarterial option in the management of pancreatic cancer.

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Treatment of locally advanced pancreatic cancer with irreversible electroporation – a Danish single center study of safety and feasibility

Cited by 23 publications

References 26 publications

Percutaneous Irreversible Electroporation in Locally Advanced and Recurrent Pancreatic Cancer (PANFIRE-2): A Multicenter, Prospective, Single-Arm, Phase II Study

Percutaneous Irreversible Electroporation in Locally Advanced and Recurrent Pancreatic Cancer (PANFIRE-2): A Multicenter, Prospective, Single-Arm, Phase II Study

Minimally invasive image-guided therapy of primary and metastatic pancreatic cancer

Emerging Ablative and Transarterial Therapies for Pancreatic Cancer

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