Irreversible electroporation versus radiotherapy after induction chemotherapy on survival in patients with locally advanced pancreatic cancer: a propensity score analysis

Chaobin He,Shuxin Sun,Bokang Cui,Jun Wang,Shengping Li,Yu Zhang,Xiangming Lao,Xiaojun Lin

doi:10.1186/s12885-019-5607-3

Chaobin He, Shuxin Sun + Show 6 more

Open Access

https://doi.org/10.1186/s12885-019-5607-3

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Abstract

BackgroundLocally advanced pancreatic cancer (LAPC) represents more than one third of pancreatic cancers and owns poor survival after the standard chemotherapy. Irreversible electroporation (IRE) is a novel method and has been recently used in LAPC. The aim of this study was to compare the efficacy of IRE and radiotherapy after induction chemotherapy for patients with LAPC.MethodsFrom August 2015 to August 2017, a total of 76 patients with biopsy proven LAPC and who had received IRE or radiotherapy after chemotherapy were included. Thirty-two pairs of patients were selected through propensity score matching (PSM) analysis and the efficacy of two treatments was compared.ResultsBefore PSM analysis, after induction chemotherapy, patients with LAPC benefited more in terms of overall survival (OS) and progression free survival (PFS) from IRE, compared with radiotherapy (2-year OS rates, 53.5% vs 26.9%, p = 0.039; 2-year PFS rates, 28.4% vs 13.3%, p = 0.045). After PSM analysis, the survival benefits of OS and PFS of patients after induction chemotherapy followed by IRE were more obvious than those of patients treated with radiotherapy (2-year OS rates, 53.5% vs 20.7%, p = 0.011; 2-year PFS rates, 28.4% vs 5.6%, p = 0.004). Multivariate Cox regression analysis indicated that IRE after induction chemotherapy was identified as a significant favourable factor for both OS and PFS in both the whole and matched cohort.ConclusionsInduction chemotherapy followed by IRE is superior to induction chemotherapy followed by radiotherapy for treating LAPC. A randomized clinical trial comparing the efficacy of IRE and radiotherapy after the induction chemotherapy is therefore considerable.

Highlights

Advanced pancreatic cancer (LAPC) represents more than one third of pancreatic cancers and owns poor survival after the standard chemotherapy
The superiority of chemotherapy, especially FOLFIRINOX-based regimen (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin), demonstrated in the metastatic or resectable pancreatic cancer had led to many explorations of modified FOLFIRINOX-based chemotherapy in Locally advanced pancreatic cancer (LAPC) [8, 9], the induction chemotherapy combined with radiotherapy or not for LAPC seldom result in sufficient downstaging to enable potential curative resection to be attempted
Patient characteristics A total of 76 LAPC patients were treated with Irreversible electroporation (IRE) or radiotherapy after induction chemotherapy

Summary

Introduction

Advanced pancreatic cancer (LAPC) represents more than one third of pancreatic cancers and owns poor survival after the standard chemotherapy. 50% of patients present with metastatic disease and the remaining patients (40%) present vascular involvement prohibiting upfront resection, known as locally advanced pancreatic cancer (LAPC) [2,3,4]. Higher rates of toxicity and increased cost of chemoradiotherapy contributed to dispute of the role of radiotherapy in the treatment of LAPC [12]. This unmet need prompted many researchers to examine novel treatments and optimize the current therapeutic approaches

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