Percutaneous Irreversible Electroporation for Downstaging and Control of Unresectable Pancreatic Adenocarcinoma

Narayanan, Govindarajan; Hosein, Peter J.; Arora, Geetika; Barbery, K.J.; Froud, Tatiana; Livingstone, Alan S.; Franceschi, Dido; Lima, Caio Max S. Rocha; Yrizarry, Jose M.

doi:10.1016/j.jvir.2012.09.012

Cited by 202 publications

(120 citation statements)

References 27 publications

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“…although percutaneous ire of pancreatic carcinoma is reportedly a safe procedure, our experience with two patients both of whom had complications was discouraging and was therefore abandoned [15,16]. in practice, it is sometimes difficult to find a safe path to perform even a biopsy of a pancreatic tumor, let alone precise placement of several electrodes.…”

Section: Discussionmentioning

confidence: 92%

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

Lambert¹,

Horejs²,

Krška³

et al. 2016

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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.

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Section: Discussionmentioning

confidence: 92%

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

Lambert¹,

Horejs²,

Krška³

et al. 2016

neo

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“…Two patients underwent surgical resection with margin-negative and both had long disease-free survival (11 and 14 mo). There were no procedure-related deaths [100] . IRE appears to be feasible and safe, but it doesn't improve OS compared with standard treatments, because of rapid progression of distant metastasis.…”

Section: Stereotactic Body Radiotherapymentioning

confidence: 90%

“…IRE is a nonthermal ablative technique that uses ultrashort pulsed but very strong electrical fields. Formation of nanopores and micropores in the lipid bilayer of cell membranes induces cancer cells apoptosis [99,100] . No results of randomised trial are currently available.…”

Section: Stereotactic Body Radiotherapymentioning

confidence: 99%

Current therapeutic strategies for advanced pancreatic cancer: A review for clinicians

Spadi¹

2016

WJCO

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Pancreatic cancer (PC) would become the second leading cause of cancer death in the near future, despite representing only 3% of new cancer diagnosis. Survival improvement will come from a better knowledge of risk factors, earlier diagnosis, better integration of locoregional and systemic therapies, as well as the development of more efficacious drugs rising from a deeper understanding of disease biology. For patients with unresectable, non-metastatic disease, combined strategies encompassing primary chemotherapy and radiation seems to be promising. In fit patients, new polychemotherapy regimens can lead to better outcomes in terms of slight but significant survival improvement associated with a positive impact on quality of life. The upfront use of these regimes can also increase the rate of radical resections in borderline resectable and locally advanced PC. Second line treatments showed to positively affect both overall survival and quality of life in fit patients affected by metastatic disease. At present, oxaliplatin-based regimens are the most extensively studied. Nonetheless, other promising drugs are currently under evaluation. Presently, in addition to surgery and conventional radiation therapy, new locoregional treatment techniques are emerging as alternative options in the multimodal approach to patients or diseases not suitable for radical surgery. As of today, in contrast with other types of cancer, targeted therapies failed to show relevant activity either alone or in combination with chemotherapy and, thus, current clinical practice does not include them. Up to now, despite the fact of extremely promising results in different tumors, also immunotherapy is not in the actual therapeutic armamentarium for PC. In the present paper, we provide a comprehensive review of the current state of the art of clinical practice and research in PC aiming to offer a guide for clinicians on the most relevant topics in the management of this disease.

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“…2). In a recent retrospective case series, IRE was performed in 14 pa- tients, with one patient receiving two treatments; three patients had metastatic disease; and the mean tumor size was 3.3 cm (33). Only one IRE-related complication, pancreatitis, was encountered.…”

Section: Application Of Electroporation To Percutaneous Tumor Ablationmentioning

confidence: 99%

Irreversible electroporation: the evolution of a laboratory technique to be used in interventional oncology

Deipolyi

Golberg

Yarmush

et al. 2014

Diagn Interv Radiol

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Electroporation involves applying electric field pulses to cells, leading to the alteration or destruction of cell membranes. Irreversible electroporation (IRE) creates permanent defects in cell membranes and induces cell death. By directly targeting IRE to tumors, percutaneous nonthermal ablation is possible. The history of IRE, evolution of concepts, theory, biological applications, and clinical data regarding its safety and efficacy are discussed.

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Percutaneous Irreversible Electroporation for Downstaging and Control of Unresectable Pancreatic Adenocarcinoma

Cited by 202 publications

References 27 publications

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

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

Current therapeutic strategies for advanced pancreatic cancer: A review for clinicians

Irreversible electroporation: the evolution of a laboratory technique to be used in interventional oncology

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