Multi‐disciplinary management of locally advanced pancreatic cancer with irreversible electroporation

Martin, Robert C.G.

doi:10.1002/jso.24640

Cited by 10 publications

(4 citation statements)

References 71 publications

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“…Despite its non-thermal nature, some complications may occur after IRE and the list of possible adverse events entails a heterogeneous number of complications, such as pancreatic fistula, venous and arterial thrombosis, pseudoaneurysm or pancreatic abscess (16,45). The morbidity rate can reach up to 30% and the morbidity is not nil (15).…”

Section: Complicationsmentioning

confidence: 99%

Palliative therapy in pancreatic cancer—interventional treatment with radiofrequency ablation/irreversible electroporation

Paiella

Pastena

D’Onofrio

et al. 2018

Transl. Gastroenterol. Hepatol

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Pancreatic cancer (PC) is a solid tumor with still a dismal prognosis. Diagnosis is usually late, when the disease is metastatic or locally advanced (LAPC). Only 20% of PC are amenable to surgery at the time of diagnosis and the vast majority of them, despite radically resected will unavoidably recur. The treatment of LAPC is a challenge. Current guidelines suggest to adopt systemic therapies upfront, based on multi-drugs chemotherapy regimens. However, the vast majority of patients will never experience conversion to surgical exploration and radical resection. Thus, there a large subgroup of LAPC patients where the only therapeutic chance is to offer palliative treatments, such as interventional ablative treatments, in order to obtain a cytoreduction of the tumor, trying to delay its growth and spread. Radiofrequency ablation (RFA) and irreversible electroporation (IRE) demonstrated to be safe and effective in obtaining a local control of the disease with some promising oncological results in terms of overall survival (OS). However, they should be adopted as a treatment strategy to adopt in parallel with other systemic therapies, within multidisciplinary choices. They are not free from complications, even serious, thus they should applied only in specialized centers of pancreatology. This review depicts the state of the art of the two techniques.

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Section: Complicationsmentioning

confidence: 99%

Palliative therapy in pancreatic cancer—interventional treatment with radiofrequency ablation/irreversible electroporation

Paiella

Pastena

D’Onofrio

et al. 2018

Transl. Gastroenterol. Hepatol

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“…[10][11][12][13] However, local relapse due to incomplete ablation and clinical complications associated with IRE protocols and electrode needle placement 14 limits its potential as a therapy. [15][16][17] This limitation was congruent with increasing tumor size, where a larger tumor becomes more difficult to treat without complications. 3 Current studies have extended IRE pulse protocols to the nanosecond range.…”

Section: Introductionmentioning

confidence: 98%

Moderate Heat Application Enhances the Efficacy of Nanosecond Pulse Stimulation for the Treatment of Squamous Cell Carcinoma

Edelblute

Guo

Hornef

et al. 2018

Technol Cancer Res Treat

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Nanosecond pulse stimulation as a tumor ablation therapy has been studied for the treatment of various carcinomas in animal models and has shown a significant survival benefit. In the current study, we found that moderate heating at 43°C for 2 minutes significantly enhanced in vitro nanosecond pulse stimulation-induced cell death of KLN205 murine squamous cell carcinoma cells by 2.43-fold at 600 V and by 2.32-fold at 900 V, as evidenced by propidium iodide uptake. Furthermore, the ablation zone in KLN205 cells placed in a 3-dimensional cell-culture model and pulsed at a voltage of 900 V at 43°C was 3 times larger than in cells exposed to nanosecond pulse stimulation at room temperature. Application of moderate heating alone did not cause cell death. A nanosecond pulse stimulation electrode with integrated controllable laser heating was developed to treat murine ectopic squamous cell carcinoma. With this innovative system, we were able to quickly heat and maintain the temperature of the target tumor at 43°C during nanosecond pulse stimulation. Nanosecond pulse stimulation with moderate heating was shown to significantly extend overall survival, delay tumor growth, and achieve a high rate of complete tumor regression. Moderate heating extended survival nearly 3-fold where median overall survival was 22 days for 9.8 kV without moderate heating and over 63 days for tumors pulsed with 600, 100 ns pulses at 5 Hz, at voltage of 9.8 kV with moderate heating. Median overall survival in the control groups was 24 and 31 days for mice with untreated tumors and tumors receiving moderate heat alone, respectively. Nearly 69% (11 of 16) of tumor-bearing mice treated with nanosecond pulse stimulation with moderate heating were tumor free at the completion of the study, whereas complete tumor regression was not observed in the control groups and in 9.8 kV without moderate heating. These results suggest moderate heating can reduce the necessary applied voltage for tumor ablation with nanosecond pulse stimulation.

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“…It is clear that defeating this cancer will require a multi‐agent and multi‐pronged strategy. It may require combining agents that dissolve the cancer‐protecting stroma, with small molecules, and antibodies targeting cancer growth and metastasis pathways . It may require adding molecules, viruses, and cells active in cancer killing through stimulation of the immune system, or vaccines to prevent recurrence …”

mentioning

confidence: 99%

Accelerating progress in the fight against pancreatic cancer Proceedings of the 2017 Leo and Anne Albert Symposium for Pancreatic Cancer Research

Melstrom

Singh

Fong

2017

Journal of Surgical Oncology

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Multi‐disciplinary management of locally advanced pancreatic cancer with irreversible electroporation

Cited by 10 publications

References 71 publications

Palliative therapy in pancreatic cancer—interventional treatment with radiofrequency ablation/irreversible electroporation

Palliative therapy in pancreatic cancer—interventional treatment with radiofrequency ablation/irreversible electroporation

Moderate Heat Application Enhances the Efficacy of Nanosecond Pulse Stimulation for the Treatment of Squamous Cell Carcinoma

Accelerating progress in the fight against pancreatic cancer Proceedings of the 2017 Leo and Anne Albert Symposium for Pancreatic Cancer Research

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