Abstract
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.
Highlights
Pancreatic cancer (PC) remains a highly lethal disease
The purpose of this review is to present an overview on safety, feasibility, oncological results, survival and quality of life improvement obtained by Irreversible Electroporation (IRE) as treatment of unresectable locally advanced pancreatic cancer (LAPC) and borderline resectable LAPC
A systematic search was performed in PubMed, regarding the use of IRE on PC in humans, using the search words ‘electroporation AND pancreas OR electroporation AND pancreatic OR irreversible electroporation OR IRE’ for studies published in English up to March 2019
Summary
Pancreatic cancer (PC) remains a highly lethal disease. Currently, it is the fifth leading cause of death from cancer in men and the fourth in women in Italy. Cancers 2019, 11, 1718 survival, but only the 15–20% of patients presenting PC are effectively candidates for resection [2] This happens because at the time of presentation, due to a diagnostic delay, about the 30% of patients present locally advanced unresectable tumours, and 50% present metastatic disease; in all about the 80% of patients are not candidates for surgical resection [3]. Those factors include nonspecific symptoms that lead to delayed diagnosis, biological aggressiveness, which is resistant to chemotherapy, and surgical consideration that can be technically demanding In this context there is a subset of patients with locally advanced pancreatic cancer (LAPC) which is less straightforward. 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
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