Elsevier

Current Problems in Cancer

Volume 37, Issue 5, September–October 2013, Pages 262-265
Current Problems in Cancer

Irreversible electroporation: A novel pancreatic cancer therapy

https://doi.org/10.1016/j.currproblcancer.2013.10.002Get rights and content

Section snippets

Background

Approximately 43,000 new cases of pancreatic ductal adenocarcinoma (PDAC) are identified yearly in the United States. Surgical resection offers the only chance for cure with 5-year survival rates approaching 20%. However, only 80% of patients are candidates for a potentially curative resection because of metastatic disease (50%) or locally advanced tumors (30%). Perhaps more than any other stage of pancreatic cancer, patients with stage III locally advanced or unresectable tumors derive the

Safety

The application of IRE technology to PDAC represents a unique dilemma. First, the pancreas is a retroperitoneal structure that is intimately associated with multiple vital blood vessels and the bile duct, all of which need to be preserved. Second, the pancreas is a gland that is susceptible to autodigestive pancreatitis and pancreatic fistulae formation, which can be devastating, life-threatening complications for patients. Using a swine model, Bower et al5 reported that IRE of the pancreas was

Efficacy

The first application of IRE to human pancreatic tumors began ca 2009. As a result, data on the efficacy of this new technology are relatively limited. Martin et al7 published an update on their multi-institutional experience of 54 patients undergoing IRE in 2012. In this study, propensity-matched comparison with standard chemotherapy or chemoradiation therapy was performed and suggested an improvement in local progression-free survival (14 vs 6 months, P = 0.01), distant progression-free

Patient selection

Locally advanced pancreatic cancer has a 5-year survival rate <5% and has great room for improvement. For patients with localized disease, the potential for improved survival by effective tumor ablation is significant. As IRE is a local therapy, selecting for tumors that are locally aggressive in the absence of metastatic disease seems the most appropriate. Currently, we offer IRE to patients with locally advanced disease who have already exhausted traditional systemic (chemotherapy) and local

Technique

Our center began selectively using IRE for locally advanced pancreatic tumors in 2012, and to date, we have performed 7 electroporations (unpublished data). Two of these electroporations have been performed in situ (Fig 1A) and 5 for margin augmentation (Fig 1B) in combination with a resection. Our current selection criteria include patients with locally advanced stage III pancreatic cancer who have already been treated with standard chemoradiation therapy for >4 months and have no evidence of

Further investigation

The adaptation of IRE for pancreatic tumor therapy appears safe but the efficacy remains in the early evaluation phase. Current retrospective data on IRE for locally advanced tumors suffer from selection bias, and long-term follow-up is still unavailable. A multi-institutional prospective trial comparing this technique to traditional chemoradiation therapy is necessary before this therapy is universally adopted. Appropriate end points for such a trial should focus on safety, overall survival,

First page preview

First page preview
Click to open first page preview

References (7)

There are more references available in the full text version of this article.

Cited by (0)

View full text