Clinical Study
Percutaneous Irreversible Electroporation for Downstaging and Control of Unresectable Pancreatic Adenocarcinoma

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Abstract

Purpose

Treatment of unresectable locally advanced pancreatic cancer (LAPC) usually includes chemotherapy and/or radiation therapy in an attempt to downstage these tumors to the extent of resectability, but outcomes remain poor. Irreversible electroporation (IRE) is an ablative modality that may be useful in this population. The aim of this study was to evaluate the safety of percutaneous IRE in patients with pancreatic adenocarcinoma.

Materials and Methods

IRE was performed in patients with pancreatic cancer whose tumors remained unresectable after, or who were intolerant of, standard therapy. The procedures were all done percutaneously under general anesthesia. Patients were then followed for adverse events, tumor response, and survival.

Results

Fifteen IRE procedures were performed in 14 patients (one was treated twice). Three patients had metastatic disease and 11 had LAPC. All patients had received chemotherapy previously, and 11 had received radiation. The median tumor size was 3.3 cm (range, 2.5–7 cm). Immediate and 24-hour postprocedural scans demonstrated patent vasculature in the treatment zone in all patients. Two patients underwent surgery 4 and 5 months after IRE, respectively. Both had margin-negative resections, and one had a pathologic complete response; both remain disease-free after 11 and 14 months, respectively. Complications included spontaneous pneumothorax during anesthesia (n = 1) and pancreatitis (n = 1), and both patients recovered completely. There were no deaths directly related to the procedure. All three patients with metastatic disease at IRE died from progression of their disease.

Conclusions

Percutaneous IRE for pancreatic adenocarcinoma is feasible and safe. A prospective trial is being planned.

Section snippets

MATERIALS AND METHODS

An institutional review board–approved retrospective analysis was performed on all patients with pancreatic adenocarcinoma treated with percutaneous IRE at a single institution. The primary objective of this analysis was to evaluate the safety and feasibility of this modality for pancreatic tumors. Secondary objectives were to determine the response to treatment and survival after the procedure. Data were collected on baseline characteristics for all patients treated, and all pre- and

RESULTS

Between December 2010 and February 2012, 14 patients with pancreatic adenocarcinoma underwent IRE procedures at our institution. One patient with LAPC who underwent IRE had local progression of disease after 7 months and was treated again with IRE. Therefore, a total of 15 percutaneous IRE procedures were performed on 14 patients. Table 1 shows the baseline pretreatment characteristics of the treated patients. Twelve of these 15 cases had disease localized to the pancreas, and the remaining

DISCUSSION

IRE is a relatively new nonthermal modality for ablation of soft-tissue tumors. Since the technology became available at our institution, it has been used for percutaneous ablation of soft-tissue tumors as well as on an off-label basis in organs such as the liver, lungs, kidneys, and prostate (27). After acquiring experience in the technique, we began using IRE percutaneously to ablate pancreatic tumors. To our knowledge, our experience is the largest series of patients treated with

Acknowledgments

The authors thank Monica T. Garcia-Buitrago, MD, Associate Professor Clinical Pathology, University of Miami Miller School of Medicine and Jackson Memorial Hospital.

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