Comparison of combination therapies in the management of locally advanced pancreatic cancer: Induction chemotherapy followed by irreversible electroporation vs radiofrequency ablation.

Chaobin He,Zhiyuan Cai,Shengping Li,Jun Wang,Xiaojun Lin,Yu Zhang

doi:10.1002/cam4.3119

Abstract

BackgroundLocally advanced pancreatic cancer (LAPC) remains a challenge for current treatments. Local destructive therapies, such as irreversible electroporation (IRE) and radiofrequency ablation (RFA), were used more and more frequently in the treatment of LAPC.ObjectiveThis study aimed to compare the efficacy of IRE with RFA in patients with LAPC.MethodsFrom August 2015 to August 2017, 58 LAPC patients after IRE or RFA therapy, which was performed through open approach, were retrospectively reviewed. The survival outcomes after IRE (36 patients) and RFA (18 patients) were compared after propensity score matching (PSM) analysis.ResultsBefore PSM analysis, IRE after the induction chemotherapy resulted in significant higher overall survival (OS) rates and progression‐free survival (PFS) rates to RFA (2‐year OS, 53.5% vs 30.8%, P = .013; 2‐year PFS, 28.4% vs 12.1%, P = .043). After PSM analysis, compared with RFA, the survival benefit of IRE was even more obvious, (2‐year OS, 53.5% vs 27.0%, P = .010; 2‐year PFS, 28.4% vs 6.4%, P = .018). For patients with tumor larger than 4 cm, IRE resulted in comparable OS and PFS between RFA and IRE while IRE also achieved better long‐term OS to RFA for those with tumor smaller than 4 cm. Multivariate analysis illustrated that IRE was a favorable prognostic factor in terms of OS and PFS in patients with LAPC.ConclusionsIRE after induction chemotherapy is superior to RFA after induction chemotherapy for treating LAPC patients while these two therapies have comparable efficacy for tumors which were larger than 4 cm.

Highlights

Pancreatic cancer (PC) is associated with poor survival with a dismal 5-year survival rate of only 7%.1 There was little significant progress in the treatment of PC during the past two decades.[23]
More than half (55%) of patients have metastatic PC. Another 40% of patients were classified as locally advanced PC (LAPC), which were characterized with vascular involvement prohibiting upfront resection.[4,5,6]
Patients who were diagnosed with Locally advanced pancreatic cancer (LAPC) and had received irreversible electroporation (IRE) or radiofrequency ablation (RFA) combined with induction chemotherapy from August 2015 to August 2017 at Sun Yat-sen University Cancer Center were retrospectively reviewed

Summary

| INTRODUCTION

Pancreatic cancer (PC) is associated with poor survival with a dismal 5-year survival rate of only 7%.1 There was little significant progress in the treatment of PC during the past two decades.[23]. The most frequently recommended treatment was chemotherapy and chemoradiotherapy, which only achieved modest survival benefit for patients with LAPC.[7] The median overall survival (OS) was only 9-12 months for LAPC patients treated with chemotherapy or chemoradiotherapy.[8,9,10] In addition, it was shown that locally destructive disease was responsible for half of mortalities in patients with LAPC, distant metastasis was found to be the most common form of disease progression,[11] indicating the importance of local destructive therapies. Considering the limited success of current therapy for the local control of disease and prolonging survival of patients with LAPC, novel local destructive therapies have been tried and viewed as more and more important treatments.[12]. The primary aim of this study was the OS comparison and the secondary aim was the progression-free survival (PFS) comparison in LAPC patients who received IRE and RFA after the induction chemotherapy

| METHODS

| RESULTS

| DISCUSSION

Findings

CONFLICT OF INTERESTS