Irreversible Electroporation In The Management Of Local Advanced Pancreatic Adenocarcinoma: A Pure Palliative Technique Or A Major Prospect Even In Resectable Pancreatic Adenocarcinomas?

Carlo Molino, MD, Antonio Braucci, MD, Antonello Niglio, MD, Salvatore Minelli, MD, Francesco La Rocca, MD, Manuela Sellini, MD, Guido De Sena, MD


OBJECTIVE Local advanced pancreatic adenocarcinoma (LAPC) is characterized by poor prognosis. Chemotherapy and radiation therapy both show limited success, mainly focusing on pain control. Nowadays, unfortunately the only treatment for unresectable pancreatic tumors consists of palliative cares. Irreversible electroporation (IRE) is an innovative loco-regional therapy in which high voltage pulses are applied to induce plasma membrane defects leading to cellular death via apoptosis. IRE has been used successfully on liver and prostatic tissues in animal and human cancers. We assumed that this new technique could be used even on human pancreatic tissue. The aim of this study is therefore to demonstrate the safety and effectiveness of this technology in palliative and hopefully curative management of LAPC.

METHODS The NanoKnife IRE System by Angiodynamics represents the absolute scientific innovation in the field of electromedical technologies, allowing molecular surgery based on a non-thermal ablation procedure. IRE bases on the ultrasound (US)-guided placement of electrodes into or around the target tissue through laparotomy and/or laparoscopy and/or percutaneous approach. The delivery of a series of intense but short-microsecond-low energy- electric pulses for approximately one minute induces the rearrangement of the cell membrane’s lipid bilayer leading to the expression of micropores. Through these openings, components of the internal side of the cell migrate in the outer cellular space causing cell death via apoptosis. Affecting only the cell membrane and not leading to temperature’s increase, the NanoKnife IRE System has the ability to not induce thermal damage in the ablated area and to spare important components of the tissues such as extracellular matrix, major blood vessels, myelin sheaths, and nerves.

PRELIMINARY RESULTS We present the case of a 59-year-old man with surgically unresectable stage III (T4N1M0) pancreatic adenocarcinoma of the body-tail (60x30mm) encasing the superior mesenteric vessels and the small gastric curve. The patient underwent a 6 months neo-adjuvant gemcitabine-based chemotherapy, according to the international guidelines for pancreatic cancer, in order to achieve the laparotomic resection. Once laparotomy showed again no space for surgery, US-guided IRE was therefore performed. Intra operative US control showed a rearranged area corresponding to the above-mentioned mass. The patient was discharged 6 days after the procedure. One month, 3 and 6 months CT-scan follow-up has shown a reduction of the mass (40x22mm VS 60x30mm) in the pancreas, of the lymph nodes involvement and of the mesenteric vessels encasement. CA 19.9 level’s trend showed a decrease of the marker related with the imaging.

CONCLUSIONS Irreversible electroporation seems to be a feasible and potentially safe method for local tumor control in LAPC in selected patients after standard induction chemotherapy. Considering the natural history of the pancreatic adenocarcinoma, IRE could maybe not improve the overall survival and the disease-free interval in those patients but could for sure ameliorate others outcome, such as pain control and jaundice, influencing thus their quality of life. Further studies are needed to elucidate the real advantages of this innovative technique and its possible application even in the management of resectable pancreatic adenocarcinomas instead of conventional surgery.

Session: Poster Presentation

Program Number: ETP025

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