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Usefulness of Imaging Response Assessment after Irreversible Electroporation of Localized Pancreatic Cancer-Results from a Prospective Cohort.

ABSTRACT: (1) Background: Irreversible electroporation (IRE) is a nonthermal ablation technique that is being studied in nonmetastatic pancreatic cancer (PC). Most published studies use imaging outcomes as an efficacy endpoint, but imaging interpretation can be difficult and has yet to be correlated with survival. The aim of this study was to examine the correlation of imaging endpoints with survival in a cohort of IRE-treated PC patients. (2) Methods: Several imaging endpoints were examined before and after IRE on ¹⁸F-fluorodeoxyglucose positron emission tomography (PET) with computed tomography. Separate analyses were performed at the patient and lesion levels. Mortality rate (MR) ratios for imaging endpoints after IRE were estimated. (3) Results: Forty-one patients were included. Patient-level analysis revealed that progressive disease (PD), as defined by RECIST 1.1, is correlated with a higher MR at all time intervals, but PD, as defined by EORTC PET response criteria, is only correlated with the MR in the longest interval. No correlation was found between PD, as defined by RECIST, and the MR in the lesion-level analysis. (4) Conclusions: Patient-level PD, as defined by RECIST, was correlated with poorer survival after IRE ablation, whereas no correlations were observed in the lesion-level analyses. Several promising lesion-level outcomes were identified.

SUBMITTER: Flak RV

PROVIDER: S-EPMC8226515 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Irreversible electroporation for the treatment of localized prostate cancer: a summary of imaging findings and treatment feedback.

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| S-EPMC5602361 | biostudies-literature

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| S-EPMC6385305 | biostudies-literature

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Irreversible Electroporation.

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| S-EPMC8268790 | biostudies-literature

Systematic Review of Irreversible Electroporation Role in Management of Locally Advanced Pancreatic Cancer.

Project description:BACKGROUND:Ablative techniques provide in patients with locally advanced pancreatic cancer (LAPC) symptomatic relief, survival benefit and potential downsizing. Irreversible Electroporation (IRE) represents potentially an ideal solution as no thermal tissue damage occurs. The purpose of this review is to present an overview on safety, feasibility, oncological results, survival and quality of life improvement obtained by IRE. METHODS:A systematic search was performed in PubMed, regarding the use of IRE on PC in humans for studies published in English up to March 2019. RESULTS:15 original studies embodying 691 patients with unresectable LAPC who underwent IRE were included. As emerged, IRE works better on tumour sizes between 3-4 cm. Oncological results are promising: median OS from diagnosis or treatment up to 27 months. Two groups investigated borderline resectable tumours treated with IRE before resection with margin attenuation, whereas IRE has proved to be effective in pain control. CONCLUSIONS:Electroporation is bringing new hopes in LAPC management. The first aim of IRE is to offer a palliative treatment. Further efforts are needed for patient selection, as well as the use of IRE for 'margin accentuation' during surgical resection. Even if promising, IRE needs to be validated in large, randomized, prospective series.

| S-EPMC6896066 | biostudies-literature

Controllable Moderate Heating Enhances the Therapeutic Efficacy of Irreversible Electroporation for Pancreatic Cancer.

Project description:Irreversible electroporation (IRE) as a non-thermal tumor ablation technology has been studied for the treatment of pancreatic carcinoma and has shown a significant survival benefit. We discovered that moderate heating (MH) at 43?°C for 1-2?minutes significantly enhanced ex vivo IRE tumor ablation of Pan02 cells by 5.67-fold at 750?V/cm and by 1.67-fold at 1500?V/cm. This amount of heating alone did not cause cell death. An integrated IRE system with controllable laser heating and tumor impedance monitoring was developed to treat mouse ectopic pancreatic cancer. With this novel IRE system, we were able to heat and maintain the temperature of a targeted tumor area at 42?°C during IRE treatment. Pre-heating the tumor greatly reduced the impedance of tumor and its fluctuation. Most importantly, MHIRE has been demonstrated to significantly extend median survival and achieve a high rate of complete tumor regression. Median survival was 43, 46 and 84 days, for control, IRE with 100??s, 1?Hz, 90 pulses and electric fields 2000-2500?V/cm and MHIRE treatment respectively. 55.6% of tumor-bearing mice treated with MHIRE were tumor-free, whereas complete tumor regression was not observed in the control and IRE treatment groups.

| S-EPMC5603521 | biostudies-literature

An update on the role of irreversible electroporation in locally advanced pancreatic adenocarcinoma.

Project description: Not available

| S-EPMC5061020 | biostudies-literature

Irreversible electroporation for the management of pancreatic cancer: Current data and future directions.

Project description:Pancreatic cancer is currently the seventh leading cause of cancer death (4.5% of all cancer deaths) while 80%-90% of the patients suffer from unresectable disease at the time of diagnosis. Prognosis remains poor, with a mean survival up to 15 mo following systemic chemotherapy. Loco-regional thermal ablative techniques are rarely implemented due to the increased risk of thermal injury to the adjacent structures, which can lead to severe adverse events. Irreversible electroporation, a promising novel non-thermal ablative modality, has been recently introduced in clinical practice for the management of inoperable pancreatic cancer as a safer and more effective loco-regional treatment option. Experimental and initial clinical data are optimistic. This review will focus on the basic principles of IRE technology, currently available data, and future directions.

| S-EPMC9846938 | biostudies-literature

Irreversible Electroporation in Patients with Pancreatic Cancer: How Important Is the New Weapon?

Project description:BackgroundPancreatic cancer (PC) is a deadly disease with poor prognosis in the general population. We aimed to quantitate overall survival of patients with PC after irreversible electroporation (IRE) and the incidence of relevant complications.MethodsWe performed a literature search via five electronic databases (PubMed, Embase, Web of Science, Scopus, and Cochrane Library databases) up to August 2017. The primary outcomes were overall survival and prognosis. Secondary outcomes included the response of post-IRE complications. Fixed-effects or random-effects meta-analysis was conducted to pool these data.ResultsA total of 15 eligible articles involving 535 patients were included. The primary outcomes showed that the pooled prevalence estimates of overall survival were 94.1% (95% CI: 90.7-97.5), 80.9% (95% CI: 72.5-89.4), 54.5% (95% CI: 38.3-70.6), and 33.8% (95% CI: 14.2-53.5) at 3, 6, 12, and 24 months, and the pooled prevalence data of complete response (CR) at 2 months, partial response (PR) at 3 months, and progression at 3 months were 12.5% (95% CI: 2.9-22.2), 48.5% (95% CI: 39.4-57.6), and 19.7% (95% CI: 7.3-32.2), respectively. The secondary outcomes showed that the pooled prevalence values of post-IRE complications were abscess 6.6% (95% CI: 0.2-13), fistula 10.6% (95% CI: 2.5-18.7), pain 33.5% (95% CI: 14.5-52.5), infection 16.1% (95% CI: 3.9-28.4), thrombosis 4.9% (95% CI: 1.2-8.5), pancreatitis 7.2% (95% CI: 3.1-11.2), bleeding 4.2% (95% CI: -0.5-8.9), cholangitis 4.2% (95% CI: -0.5-8.9), nausea 9.6% (95% CI: 4.4-14.8), biliary obstruction 13.8% (95% CI: 4.2-23.3), chest tightness 7.6% (95% CI: 0.5-14.6), and hypoglycemia 5.9% (95% CI: -0.4-12.2).ConclusionsThis meta-analysis indicated a clear survival benefit for PC patients who received irreversible electroporation therapy, although future safety and effectivity monitoring from more large-scale studies will be needed.

| S-EPMC5944201 | biostudies-literature

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