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It is reasonable to consider the technical possibility and oncological feasibility of the local tumor destruction in patients with locally advanced pancreatic cancer (PCa). Irreversible electroporation (IRE) is a non-thermal method of local tumor ablation, which uses non-thermal energy of high-voltage ultrashort electric fields localized between electrodes to create nanopores in the cellular wall with the following cellular death. The zone of impact can be accurately predicted using the location of the electrodes. A fairly clear and controlled ablation boundary without a clinically significant zone of perifocal tissue damage reduces the risk of accidental injury to the wall of a hollow organ. The method is based on a change in the permeability of the cell membrane and the development of apoptosis, which allows to act directly on the ducts and the great vessels infiltrated by the tumor without a high risk of damage. The presented case shows that IRE is advisable to use as a part of the combined treatment of patients with locally advanced PCa. There were no complications observed after the IRE. Radiological evaluations and pathologic reports showed an adequate long-term local control. Also, good results were obtained in the overall life expectancy, given that we are talking about unresectable ductal adenocarcinoma of the pancreas. The patient passed away in 39 months from the beginning of the treatment and in 26 months from the initial IRE. In case of local relapse, repeated electroporation with a good long-term result is also possible. The time to progression exceeded eleven months after electroporation performed for a local relapse. According to magnetic resonance imaging, both locoregional relapse and distant liver metastases were detected. The patient lived 16 months after a repeated IRE session and died of pulmonary embolism on the background of chemotherapy. Favorable prognostic factors are the presence of an objective response to previous conservative treatment, compliance with the parameters of electroporation, complete inclusion of tumor infiltration in the affected area.

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов. Conflict of interest. The authors declare no conflict of interests.Финансирование. Работа выполнена без спонсорской поддержки. Funding. The work was performed without external funding.

Background. The results of local destruction methods in locally advanced pancreatic cancer (LAPCa) are contradictory. Radiation therapy is the most commonly used. Other methods are used much less frequently, irreversible electroporation (IRE) is one of them. Most authors indicate an acceptable level of complications and mortality, but without an improvement in long-term results. The results of two meta-analyses have been published, the authors indicate the possibility of using the IRE in selected patients. The authors also point out that minimally invasive methods of using the IRE be preferred. Some experience has been gained in the use of percutaneous access for IRE in LAPCa. Computed tomography, ultrasound guidance can be used for navigation. The level of complications can reach 50 %. Mortality with percutaneous access, as a rule, is absent or does not exceed 5 %. Long-term results are the same with the results of open IRE.Aim. To share authors experience of using percutaneous irreversible electroporation in pancreatic cancer, because there are no references to the use of percutaneous IRE in LAPCa in Russia.Materials and methods. The IRE was performed for 53-year female patient with LAPCa after successful induction therapy. A step-by-step pulse effect of electrodes installed under ultrasound control on the tumor infiltrate was carried out. Magnetic resonance imaging, computed tomography and other types of studies were used for diagnostic purposes.Results. The involvement of the common hepatic artery and portal vein remained after the induction therapy, which did not allow performing pancreatoduodenal resection. Ultrasonic navigation and flat-detector computed tomography allowed to install the electrodes adequatly and safely. The impact zone almost completely blocked the infiltrate zone, a more optimal location of the electrodes was limited by the wide network of venous collaterals. Magnetic resonance imaging data performed before and after the procedure showed no progression of the disease within more than three months after the procedure, including in the affected area. Tumor shrinkage was noted as a partial response.Conclusion. The first experience confirmed the safety and the absence of subsequent complications when using the percutaneous access method of IRE for LAPCa. Follow-up monitoring of the patient will allow to say more correctly about the possibility of the method to provide long-term local control.

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