Treatment of locally advanced pancreatic cancer by percutaneous and intraoperative irreversible electroporation: general hospital cancer center experience

Abstract

The aim of this study was to evaluate the safety of irreversible electroporation (ire) and the outcome of patients undergoing ire of locally advanced pancreatic cancer (Pc). twenty-one patients with unresectable Pc underwent open (n=19) or percutaneous (n=2) ire of the tumor using the Nanoknife system with two electrodes that were repositioned several times to affect the whole mass. The size of the tumor was 39±10mm with a range from 21 to 65mm. Five patients underwent neoadjuvant chemotherapy and seven patients were treated with chemotherapy after ire. complications occurred in five patients, which resulted in prolongation of the average hospital stay from 10 to 34 days. There was no mortality in the first postoperative month. median survival after ire was 10.2 months compared to 9.3 months in a matched cohort (hazard ratio = .54, p = .053). The quality of life was declining slowly. 81% of time after ire the Karnofsky performance status was ≥70 and sharp decline occurred approximately 8 weeks before death.in conclusion, ire is a safe palliative treatment option for a percentage of patients with locally advanced pancreatic carcinoma. The patients treated with open ire lived a decent life until 8 weeks before their death. We believe that ire of pancreatic carcinoma can be regarded as an option, if imaging or explorative laparotomy show that r0 resection in not possible.

Locally Advanced Pancreatic Cancer: A Review of Local Ablative Therapies

“…Fourteen single arm studies were published regarding IRE for LAPC, either as margin accentuation [ 67 , 68 , 69 , 70 ] or as primary tumor treatment [ 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 ]. Patients were treated percutaneously [ 69 , 71 , 72 , 73 , 74 , 75 , 77 , 80 ], laparoscopically [ 70 ], or during laparotomy [ 68 , 69 , 70 , 72 , 73 , 76 , 78 , 79 ]. After a median follow-up of 1–29 months, the median OS from diagnosis ranged between 15.3 and 27.0 months [ 68 , 70 , 74 , 75 , 76 , 77 , 78 ], whilst the median OS from IRE varied between 7.0 months and 14.2 months [ 67 , 73 , 74 , 75 , 77 , 81 ].…”

“…Patients were treated percutaneously [ 69 , 71 , 72 , 73 , 74 , 75 , 77 , 80 ], laparoscopically [ 70 ], or during laparotomy [ 68 , 69 , 70 , 72 , 73 , 76 , 78 , 79 ]. After a median follow-up of 1–29 months, the median OS from diagnosis ranged between 15.3 and 27.0 months [ 68 , 70 , 74 , 75 , 76 , 77 , 78 ], whilst the median OS from IRE varied between 7.0 months and 14.2 months [ 67 , 73 , 74 , 75 , 77 , 81 ]. In the study from Martin et al, the difference in OS between patients treated with IRE for primary tumor control (median OS: 23.2 months) was compared to IRE as margin accentuation after resection (median OS: 28.3 months).…”

“…Major complications (grade 3 or higher) varied between none to 30% [ 67 , 71 , 74 , 75 , 80 ], whilst overall morbidity ranged between 10 and 57% [ 68 , 69 , 72 , 73 , 74 , 76 , 77 , 78 , 79 ]. Most frequently encountered (major) complications were abdominal pain [ 75 , 77 ]; GI-related adverse events such as nausea and anorexia [ 67 , 68 , 70 , 72 , 77 ], delayed gastric emptying or ileus [ 67 , 69 , 70 , 72 , 74 , 77 , 78 , 79 ], and (perforated) ulcers with or without GI bleeding [ 67 , 74 , 77 , 78 , 79 ]; portal vein thrombosis [ 67 , 68 , 69 , 70 , 72 , 74 , 75 , 78 , 79 ]; biliary stricture; leakage or cholangitis [ 67 , 68 , 69 , 70 , 72 , 73 , 77 , 78 ]; pancreatic leakage; fistula or pancreatitis [ 70...…”

Irreversible Electroporation of the Pancreas

“…15,16 In the meta-analyses by Ansari et al, 8 there were a total of 9 mortalities in 446 patients (2%). Severe complication rate was reported to be between 0 and 24%, 17,18 while minor complication rate ranged from 10 to 62%. 12,19 In the largest experience of 200 patients published by Martin et al, 9 20 (40%) of the resected patients and 54 (36%) of the nonresected patients experienced a total of 49 and 100 complications, respectively.…”

Adjuvant, neoadjuvant, and experimental regimens in overcoming pancreatic ductal adenocarcinoma

“…Lambert et al showed that although intraoperative IRE does not result in improved overall survival, it can ameliorate the quality of life (Karnofsky score). Therefore, electroporation constitutes a safe palliative treatment option for patients with unresectable tumours [ 69 ].…”