Percutaneous irreversible electroporation for downstaging and control of unresectable pancreatic adenocarcinoma

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

Research output: Contribution to journalArticle

142 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1613-1621
Number of pages9
JournalJournal of Vascular and Interventional Radiology
Volume23
Issue number12
DOIs
StatePublished - Dec 1 2012

Fingerprint

Electroporation
Adenocarcinoma
Pancreatic Neoplasms
Neoplasms
Drug Therapy
Pneumothorax
Pancreatitis
General Anesthesia
Disease Progression
Radiotherapy
Therapeutics
Anesthesia
Radiation
Safety

Keywords

  • EFS
  • event-free survival
  • IRE
  • irreversible electroporation
  • LAPC
  • locally advanced pancreatic cancer
  • OS
  • overall survival
  • radiofrequency
  • RF

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Percutaneous irreversible electroporation for downstaging and control of unresectable pancreatic adenocarcinoma. / Narayanan, Govindarajan; Hosein, Peter; Arora, Geetika; Barbery, Katuzka J.; Froud, Tatiana; Livingstone, Alan; Franceschi, Dido; Rocha Lima, Caio M.; Yrizarry, Jose.

In: Journal of Vascular and Interventional Radiology, Vol. 23, No. 12, 01.12.2012, p. 1613-1621.

Research output: Contribution to journalArticle

Narayanan, Govindarajan ; Hosein, Peter ; Arora, Geetika ; Barbery, Katuzka J. ; Froud, Tatiana ; Livingstone, Alan ; Franceschi, Dido ; Rocha Lima, Caio M. ; Yrizarry, Jose. / Percutaneous irreversible electroporation for downstaging and control of unresectable pancreatic adenocarcinoma. In: Journal of Vascular and Interventional Radiology. 2012 ; Vol. 23, No. 12. pp. 1613-1621.
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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.",
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AU - Hosein, Peter

AU - Arora, Geetika

AU - Barbery, Katuzka J.

AU - Froud, Tatiana

AU - Livingstone, Alan

AU - Franceschi, Dido

AU - Rocha Lima, Caio M.

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N2 - 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.

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