Abstract
Simple SummaryIrreversible electroporation (IRE) is a novel therapy that is being studied for the treatment of nonmetastatic pancreatic cancer. The current methods for evaluating the treatment response after IRE have been adapted from the Response Evaluation Criteria in Solid Tumors (RECIST). However, it is uncertain whether these methods are appropriate, because the methods have not been validated. The aim of the current study was to evaluate the correlation between survival time and the most commonly used imaging assessment methods on FDG-PET/CT scans. We confirmed that the Response Evaluation Criteria in Solid Tumors (RECIST) are correlated with survival, when applied as intended. However, no correlation was found when the often-used lesion-level method was used. FDG-PET-derived data did not provide any benefit over conventional CT data. Several novel methods for lesion-level analysis were explored.(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.
Highlights
Pancreatic cancer (PC) is one of the deadliest and most challenging common cancers to treat
When introducing new ablative therapies, it is often straightforward to provide evidence of safety and feasibility, whereas in the absence of randomized controlled trials, it can be difficult to answer the following questions: Is the treatment efficacious, and how do we evaluate the response to the treatment? Imaging outcomes have been widely adopted as a surrogate marker of treatment efficacy after Irreversible electroporation (IRE) and other ablative treatments in locally advanced PC but can be difficult to interpret [12,13]
By examining the correlation between imaging outcomes and survival in patients undergoing IRE for localized pancreatic cancer, we found that progressive disease (PD) at the patient level, as defined by RECIST 1.1, is correlated with worse survival
Summary
Pancreatic cancer (PC) is one of the deadliest and most challenging common cancers to treat. Recent oncological and surgical advances, including combination chemotherapy regimens, e.g., FOLFIRINOX, radiotherapy, and coeliac axis resection, have led to increased survival and resection rates, but surgical resection remains impossible in a substantial number of patients [3,4]. Despite the theoretical benefits of IRE, the efficacy of this treatment remains to be established, as there is only low-level evidence available to date [7]. Initial unrandomized controlled prospective trial studies are promising and indicate that the treatment could be efficacious and may induce tumor shrinkage to a resectable stage in some cases [8,9,10,11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
