Impact of irreversible electroporation on survival among patients with borderline resectable/locally advanced pancreatic cancer: A single center experience

Abstract

BackgroundThe use of Irreversible Electroporation (IRE) in borderline resectable (BR) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) is increasing. However, its potential impact on survival has been debated. We hypothesized that addition of IRE to the conventional multimodal therapy would be associated with improved overall survival (OS) in BR/LA PDAC patients. MethodsAmong patients received neoadjuvant chemotherapy, we identified PDAC patients with BR/LA disease who underwent resection alone, resection+IRE, IRE alone, and no resection but would have been eligible for IRE. Kaplan-Meier method with Peto-Peto modified log-rank test and Cox proportional hazard were used in survival analyses. Results102 patients were included in the cohort – 40 resection-only (18 % LA), 13 resection+IRE (46 % LA), 14 IRE-only (93 % LA), and 35 unresected (77 % LA). Median age was 65. IRE patients had a median follow-up of 22 months [95 %CI:14–28], while for non-IRE patients it was 17 months [95 %CI:12–26]. Median age and proportion without comorbidities did not significantly differ across groups. Median OS was 30 months [95 %CI:30-NR] among patients who underwent resection+IRE, 27 months [95 %CI:23–48] for resection-only, 28 months [95 %CI:16-NR] for IRE-only, and 14 months [95 %CI:10–20] for unresected patients. In multivariable analyses, resection (HR:0.26 [95 %CI:0.13–0.54], P < 0.001), neoadjuvant chemoradiation (HR:0.50 [95 %CI:0.28–0.88], P = 0.017), and IRE (HR:0.49 [95 %CI:0.26–0.94], P = 0.03) were independently associated with decreased risk of mortality. ConclusionsIRE may enhance survival in BR/LA PDAC patients who receive conventional multimodal therapy. Prospective studies are needed to confirm the potential benefits of IRE as an adjunct during pancreatic resection after multimodal neoadjuvant therapy for BR/LA PDAC. SynopsisIrreversible electroporation can be a valuable adjunct to the current multimodal therapy for treating borderline resectable and locally advanced pancreatic cancer.