Repeated irreversible electroporation in a locally advanced pancreatic cancer
https://doi.org/10.17709/2410-1893-2022-9-4-11
Abstract
It is reasonable to consider the technical possibility and oncological feasibility of the local tumor destruction in patients with locally advanced pancreatic cancer (PCa). Irreversible electroporation (IRE) is a non-thermal method of local tumor ablation, which uses non-thermal energy of high-voltage ultrashort electric fields localized between electrodes to create nanopores in the cellular wall with the following cellular death. The zone of impact can be accurately predicted using the location of the electrodes. A fairly clear and controlled ablation boundary without a clinically significant zone of perifocal tissue damage reduces the risk of accidental injury to the wall of a hollow organ. The method is based on a change in the permeability of the cell membrane and the development of apoptosis, which allows to act directly on the ducts and the great vessels infiltrated by the tumor without a high risk of damage. The presented case shows that IRE is advisable to use as a part of the combined treatment of patients with locally advanced PCa. There were no complications observed after the IRE. Radiological evaluations and pathologic reports showed an adequate long-term local control. Also, good results were obtained in the overall life expectancy, given that we are talking about unresectable ductal adenocarcinoma of the pancreas. The patient passed away in 39 months from the beginning of the treatment and in 26 months from the initial IRE. In case of local relapse, repeated electroporation with a good long-term result is also possible. The time to progression exceeded eleven months after electroporation performed for a local relapse. According to magnetic resonance imaging, both locoregional relapse and distant liver metastases were detected. The patient lived 16 months after a repeated IRE session and died of pulmonary embolism on the background of chemotherapy. Favorable prognostic factors are the presence of an objective response to previous conservative treatment, compliance with the parameters of electroporation, complete inclusion of tumor infiltration in the affected area.
About the Authors
A. N. PolyakovRussian Federation
Alexandr N. Polyakov – Cand. Sci. (Med.), senior researcher of the oncology department of surgical treatment methods No. 7 (tumors of the hepatopancreatobiliary zone)
24 Kashirskoye sh., Moscow 115478
SPIN: 9924-0256,
AuthorID: 764535.
Scopus Author ID: 57190413973
D. V. Podluzhnyi
Russian Federation
Danila V. Podluzhnyi – Cand. Sci. (Med.), head of the oncology department of surgical treatment methods No. 7 (tumors of the hepatopancreatobiliary zone)
Moscow
SPIN: 3537-3436,
AuthorID: 583879,
Scopus Author ID: 6506558213
N. E. Kudashkin
Russian Federation
Nikolay E. Kudashkin – Cand. Sci. (Med.), the senior researcher of the oncology department of surgical treatment methods No. 7 (tumors of the hepatopancreatobiliary zone)
Moscow
SPIN: 3574- 8344,
AuthorID: 865983,
ResearcherID: R-8764-2019,
Scopus Author ID: 54885375500
I. S. Bazin
Russian Federation
Igor S. Bazin – leading researcher of the second chemotherapeutic department
Moscow
SPIN: 2186-5878,
AuthorID: 266861,
ResearchID: J-6618-2017,
Scopus Author ID: 000326249341
B. M. Medvedeva
Russian Federation
Bela M. Medvedeva – Dr. Sci. (Med.), head of radiology department, scientific research institute of clinical and experimental radiology
Moscow
SPIN: 1160-2169,
AuthorID: 583878,
Scopus Author ID: 56563956800
A. Yu. Syskova
Russian Federation
Anna Yu. Syskova – medical oncologist, department of chemotherapy No. 2
Moscow
SPIN: 1676-6072,
AuthorID: 1118447
D. M. Kantieva
Russian Federation
Dayana M. Kantieva – oncologist of the second chemotherapeutic department
Moscow
ResearchID: GLV-5759-2022
Yu. I. Patyutko
Russian Federation
Yuriy I. Patyutko – Dr. Sci. (Med.), chief adviser of the oncology department of surgical treatment methods No. 7 (tumors of the hepatopancreatobiliary zone)
Moscow
AuthorID: 137980
References
1. Bray F, Ferlay J, Soerjomataram I, Siegel R, Torre L, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. https://doi.org/10.3322/caac.21492
2. Balaban EP, Mangu PB, Khorana AA, Shah MA, Mukherjee S, Crane CH, Javle MM, Eads JR, Allen P, Ko AH, Engebretson A, Herman JM, Strickler JH, Benson AB 3rd, Urba S, Yee NS. Locally Advanced, Unresectable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2016 Aug 1;34(22):2654–2668. https://doi.org/10.1200/JCO.2016.67.5561
3. Gong J, Tuli R, Shinde A, Hendifar AE. Meta-analyses of treatment standards for pancreatic cancer. Mol. Clin. Oncol. 2016;4:315– 325. https://doi.org/10.3892/mco.2015.716
4. Vogel JA, van Veldhuisen E, Agnass P, Crezee J, Dijk F, Verheij J, et al. Time-dependent impact of irreversible electroporation on pancreas, liver, blood vessels and nerves: a systematic review of experimental studies. PLoS ONE. 2016;11(11):e0166987. https://doi.org/10.1371/journal.pone.0166987
5. Martin RC 2nd, Kwon D, Chalikonda S, Sellers M, Kotz E, Scoggins C, et al. Treatment of 200 Locally Advanced (Stage III) Pancreatic Adenocarcinoma Patients With Irreversible Electroporation Safety and Efficacy. Ann Surg 2015;262:486–494. https://doi.org/10.1097/SLA.0000000000001441
6. Astakhov DA, Panchenkov DN, Ivanov YuV, Shablovsky OR, Kedrova AG, Soloviev NA, et al. Irreversible electroporation for locally advanced pancreatic cancer. Annaly khirurgicheskoy gepatologii = Annals of HPB surgery. 2018;23(2):59–68. (In Russ.). https://doi.org/10.16931/1995-5464.2018259-68
7. Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, et al. Increased Survival in Pancreatic Cancer with nab-Paclitaxel plus Gemcitabine. N Engl J Med 2013;369:1691–1703. https://doi.org/10.1056/NEJMoa1304369
8. Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, et al. FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic Cancer N Engl J Med 2011;364:1817–1825. https://doi.org/10.1056/NEJMoa1011923
9. Chiorean EG, Cheung WY, Giordano G, Kim G, Al-Batran SE. Real-world comparative effectiveness of nab-paclitaxel plus gemcitabine versus FOLFIRINOX in advanced pancreatic cancer: a systematic review. Ther Adv Med Oncol. 2019 May 19;11:1758835919850367. https://doi.org/10.1177/1758835919850367
10. Hammel P, Huguet F, van Laethem JL, Goldstein D, Glimelius B, Artru P, et al. Effect of Chemoradiotherapy vs Chemotherapy on Survival in Patients With Locally Advanced Pancreatic Cancer Controlled After 4 Months of Gemcitabine With or Without Erlotinib: The LAP07 Randomized Clinical Trial. JAMA. 2016;315(17):1844–1853. https://doi.org/10.1001/jama.2016.4324
11. Ionkin DA, Karelskaya NA, Stepanova YuA, Zemskov VМ, Kozlova MN, Zhavoronkova OA, et al. Cryoablation for locally аdvanced pancreatic cancer. Annals of HPB surgery. 2018;23(2):37–49. (In Russ.). https://doi.org/10.16931/1995-5464.2018237-49
12. Edd JF, Horowitz L, Davalos RV, Mir LM, Rubinsky B. In vivo results of a new focal tissue ablation technique: irreversible electroporation. IEEE Transactions on Bio-medical Engineering 2006;53:1409–1415. https://doi.org/10.1109/TBME.2006.873745
13. Narayanan G, Hosein PJ, Arora G, Barbery KJ, Froud T, Livingstone AS, et al. Percutaneous Irreversible Electroporation for Downstaging and Control of Unresectable Pancreatic Adenocarcinoma. J Vasc Interv Radiol 2012;23:1613–1621. https://doi.org/10.1016/j.jvir.2012.09.012
Supplementary files
Review
For citations:
Polyakov A.N., Podluzhnyi D.V., Kudashkin N.E., Bazin I.S., Medvedeva B.M., Syskova A.Yu., Kantieva D.M., Patyutko Yu.I. Repeated irreversible electroporation in a locally advanced pancreatic cancer. Research and Practical Medicine Journal. 2022;9(4):114-122. https://doi.org/10.17709/2410-1893-2022-9-4-11