Percutaneous Irreversible Electroporation for Downstaging and Control of Unresectable Pancreatic Adenocarcinoma

被引:203
作者
Narayanan, Govindarajan [1 ]
Hosein, Peter J. [2 ]
Arora, Geetika [1 ]
Barbery, Katuzka J. [1 ]
Froud, Tatiana [1 ]
Livingstone, Alan S. [3 ]
Franceschi, Dido [3 ]
Lima, Caio M. Rocha [2 ]
Yrizarry, Jose [1 ]
机构
[1] Univ Miami, Miller Sch Med, Dept Radiol, Div Vasc Intervent Radiol, Miami, FL 33136 USA
[2] Univ Miami, Miller Sch Med, Dept Med, Div Hematol Oncol, Miami, FL 33136 USA
[3] Univ Miami, Miller Sch Med, Dept Surg, Div Surg Oncol, Miami, FL 33136 USA
关键词
RADIOFREQUENCY ABLATION; PHASE-III; CANCER; GEMCITABINE; CARCINOMA; CHEMOTHERAPY; SAFETY; TRIAL;
D O I
10.1016/j.jvir.2012.09.012
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Purpose: Treatment of unresectable locally advanced pancreatic cancer (LAPC) usually includes chemotherapy and/or radiation therapy in an attempt to downstage these tumors to the extent of resectability, but outcomes remain poor. Irreversible electroporation (IRE) is an ablative modality that may be useful in this population. The aim of this study was to evaluate the safety of percutaneous IRE in patients with pancreatic adenocarcinoma. Materials and Methods: IRE was performed in patients with pancreatic cancer whose tumors remained unresectable after, or who were intolerant of, standard therapy. The procedures were all done percutaneously under general anesthesia. Patients were then followed for adverse events, tumor response, and survival. Results: Fifteen IRE procedures were performed in 14 patients (one was treated twice). Three patients had metastatic disease and 11 had LAPC. All patients had received chemotherapy previously, and 11 had received radiation. The median tumor size was 3.3 cm (range, 2.5-7 cm). Immediate and 24-hour postprocedural scans demonstrated patent vasculature in the treatment zone in all patients. Two patients underwent surgery 4 and 5 months after IRE, respectively. Both had margin-negative resections, and one had a pathologic complete response; both remain disease-free after 11 and 14 months, respectively. Complications included spontaneous pneumothorax during anesthesia (n = 1) and pancreatitis (n = 1), and both patients recovered completely. There were no deaths directly related to the procedure. All three patients with metastatic disease at IRE died from progression of their disease. Conclusions: Percutaneous IRE for pancreatic adenocarcinoma is feasible and safe. A prospective trial is being planned.
引用
收藏
页码:1613 / 1621
页数:9
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