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Single-Institution Experience with Irreversible Electroporation for T4 Pancreatic Cancer: First 50 Patients

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Irreversible electroporation (IRE) for treatment of locally advanced pancreatic tumors is garnering increasing attention. This study was conducted to determine perioperative morbidity and mortality for locally advanced pancreatic cancer.

Methods

Prospective data of 50 consecutive patients receiving IRE for T4 lesions at a single tertiary center were analyzed. The primary end point was Clavien–Dindo complications at 90 days, and the secondary outcomes were survival and recurrence.

Results

A total of 50 patients underwent 53 IRE procedures for primary treatment (n = 29) or margin extension (n = 24), and 47 patients had adenocarcinoma. Six patients died within 90 days after the procedure (5 in the primary control group). Mortality occurred a median of 26 days (range, 8–42 days) after the procedure. Five patients in both the margin-extension and primary control groups experienced grade 3 or 4 morbidity (p = 0.739). The incidences of grades 3 to 5 complications did not differ significantly based on the adjustable parameters of IRE, tumor size, or primary treatment versus margin extension. After a median follow-up period of 8.69 months [interquartile range (IQR), 0.26–16.26 months], the median overall survival period for the primary control group was 7.71 months [95 % confidence interval (CI), 6.03–12.0 months) and was not reached in the margin-extension group (p = 0.01, log-rank).

Conclusions

At the authors’ center, the mortality rate after IRE was higher than reported in other series, with the majority occurring in the primary control group. Major morbidity trended around upper gastrointestinal bleeding, visceral ulcerations/perforations, and portal vein thromboses. This favors further investigation of the safety and efficacy of IRE.

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References

  1. Loehrer PJ Sr, Feng Y, Cardenes H, et al. Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group trial. J Clin Oncol. 2011;29:4105–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Chauffert B, Mornex F, Bonnetain F, et al. Phase III trial comparing intensive induction chemoradiotherapy (60 Gy, infusional 5-FU and intermittent cisplatin) followed by maintenance gemcitabine with gemcitabine alone for locally advanced unresectable pancreatic cancer: definitive results of the 2000-01 FFCD/SFRO study. Ann Oncol. 2008;19:1592–9.

    Article  CAS  PubMed  Google Scholar 

  3. Sherman WH, Chu K, Chabot J, et al. Neoadjuvant gemcitabine, docetaxel, and capecitabine followed by gemcitabine and capecitabine/radiation therapy and surgery in locally advanced, unresectable pancreatic adenocarcinoma. Cancer. 2015;121:673–80.

    Article  CAS  PubMed  Google Scholar 

  4. Heinemann V, Haas M, Boeck S. Neoadjuvant treatment of borderline resectable and non-resectable pancreatic cancer. Ann Oncol. 2013;24:2484–92.

    Article  CAS  PubMed  Google Scholar 

  5. Gurusamy KS, Kumar S, Davidson BR, Fusai G. Resection versus other treatments for locally advanced pancreatic cancer. Cochrane Database of Systematic Reviews 2014, 2. Art. No.: CD010244.

  6. Martin RC, Kwon D, Chalikonda S,. et al. Treatment of 200 locally advanced (stage 3) pancreatic adenocarcinoma patients with irreversible electroporation: safety and efficacy. Ann Surg. 2015;262:486–94.

    Article  PubMed  Google Scholar 

  7. Kwon D, McFarland K, Velanovich V, Martin RC II. Borderline and locally advanced pancreatic adenocarcinoma margin accentuation with intraoperative irreversible electroporation. Surgery. 2014;156:910–20.

    Article  PubMed  Google Scholar 

  8. Martin RG II, McFarland K, Ellis S, Velanovich V. Irreversible electroporation in locally advanced pancreatic cancer: potential improved overall survival. Ann Surg Oncol. 2013;20:443–9.

    Article  Google Scholar 

  9. Martin RC II, McFarland K, Ellis S, Velanovich V. Irreversible electroporation therapy in the management of locally advanced pancreatic adenocarcinoma. J Am Coll Surg. 2012;215:361–9.

    Article  PubMed  Google Scholar 

  10. Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817–25.

    Article  CAS  PubMed  Google Scholar 

  11. Allendorf JD, Lauerman M, Bill A, et al. Neoadjuvant chemotherapy and radiation for patients with locally unresectable pancreatic adenocarcinoma: feasibility, efficacy, and survival. J Gastrointest Surg. 2008;12:91–100.

    Article  PubMed  Google Scholar 

  12. Mollberg N, Rahbari NN, Koch M, et al. Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg. 2011;254:882–93.

    Article  PubMed  Google Scholar 

  13. Narayanan G, Bhatia S, Echenique A, et al. Vessel patency post irreversible electroporation. Cardiovasc Intervent Radiol. 2014;37:1523–9.

    Article  PubMed  Google Scholar 

  14. Gawlas I, Epelboym I, Winner M, et al. Short-term but not long-term loss of patency of venous reconstruction during pancreatic resection is associated with decreased survival. J Gastrointest Surg. 2014;18:75–82.

    Article  PubMed  Google Scholar 

  15. Narayanan G, Hosein PJ, Arora G, et al. Percutaneous irreversible electroporation for downstaging and control of unresectable pancreatic adenocarcinoma. J Vasc Interv Radiol. 2012;23:1613–21.

    Article  PubMed  Google Scholar 

  16. Chang DT, Schellenberg D, Shen J, et al. Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas. Cancer. 2009;115:665–72.

    Article  PubMed  Google Scholar 

  17. Mansson C, Bergenfeldt M, Brahmstaedt R, et al. Safety and preliminary efficacy of ultrasound-guided percutaneous irreversible electroporation for treatment of localized pancreatic cancer. Anticancer Res. 2014;34:289–94.

    PubMed  Google Scholar 

  18. Dunki-Jacobs EM, Philips P, Martin RCG. Evaluation of thermal injury to liver, pancreas, and kidney during irreversible electroporation in an in vivo experimental model. BJS. 2014;101:1113–21.

    Article  CAS  Google Scholar 

  19. Ben-David E, Ahmed M, Faroja M, et al. Irreversible electroporation: treatment effect is susceptible to local environment and tissue properties. Radiology. 2013;269:738–47.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ricke J, Jürgens JH, Deschamps F, et al. Irreversible electroporation (IRE) fails to demonstrate efficacy in a prospective multicenter phase II trial on lung malignancies: the ALICE trial. Cardiovasc Intervent Radiol. 2015;38:401–8.

    Article  PubMed  Google Scholar 

  21. Wagstaff PG, de Bruin DM, van den Bos W, et al. Irreversible electroporation of the porcine kidney: temperature development and distribution. Urol Oncol. 2015;33:e1–7.

    Article  PubMed  Google Scholar 

  22. Faroja M, Ahmed M, Appelbaum L, et al. Irreversible electroporation ablation: is all the damage nonthermal? Radiology. 2013;266:462–70.

    Article  PubMed  Google Scholar 

  23. Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369:1691–703.

    Article  Google Scholar 

  24. Liao WC, Chien KL, Lin YL, et al. Adjuvant treatments for resected pancreatic adenocarcinoma: a systematic review and network meta-analysis. Lancet Oncol. 2013;14:1095–103.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors appreciate Dr. Steven Strasberg’s critical review of the manuscript.

Disclosure

There are no conflicts of interest.

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Authors and Affiliations

  1. Division of Gastrointestinal & Endocrine Surgery, Department of Surgery, New York-Presbyterian Hospital, Columbia University, College of Physicians and Surgeons, New York, NY, USA

    Michael D. Kluger MD, MPH, Irene Epelboym MD, Beth A. Schrope MD, PhD, Krishnaraj Mahendraraj MD & John A. Chabot MD

  2. Division of Abdominal Imaging, Department of Radiology, Columbia University, College of Physicians and Surgeons, New York, NY, USA

    Elizabeth M. Hecht MD

  3. Division of Vascular and Interventional Radiology, Department of Radiology, Columbia University, College of Physicians and Surgeons, New York, NY, USA

    Jonathan Susman MD & Joshua L. Weintraub MD

Authors
  1. Michael D. Kluger MD, MPH
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  2. Irene Epelboym MD
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  3. Beth A. Schrope MD, PhD
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  4. Krishnaraj Mahendraraj MD
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  5. Elizabeth M. Hecht MD
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  6. Jonathan Susman MD
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  7. Joshua L. Weintraub MD
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  8. John A. Chabot MD
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Corresponding author

Correspondence to Michael D. Kluger MD, MPH.

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Kluger, M.D., Epelboym, I., Schrope, B.A. et al. Single-Institution Experience with Irreversible Electroporation for T4 Pancreatic Cancer: First 50 Patients. Ann Surg Oncol 23, 1736–1743 (2016). https://doi.org/10.1245/s10434-015-5034-x

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  • DOI: https://doi.org/10.1245/s10434-015-5034-x

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