Brief report
Percutaneous Irreversible Electroporation of Surgically Unresectable Pancreatic Cancer: A Case Report

https://doi.org/10.1016/j.jvir.2011.10.002Get rights and content

Abstract

The present report describes a case of percutaneous irreversible electroporation (IRE) in a 78-year-old man with surgically unresectable stage III (tumor/node/metastasis stages, T4N0M0) pancreatic adenocarcinoma. Two ablations were performed for a 4.1-cm mass encasing the celiac and superior mesenteric artery. At 3 months, a solitary liver metastasis developed, which was treated with radiofrequency ablation followed by gemcitabine chemotherapy. At 6-month follow-up, magnetic resonance imaging demonstrated no residual disease and a decreasing cancer antigen 19-9 level. Percutaneous IRE shows promise as a feasible and potentially safe method for local tumor control in patients with surgically unresectable disease.

Section snippets

Case Report

A 76-year-old African American male diagnosed with stage III (tumor/node/metastasis stages T4N0M0) unresectable pancreatic cancer secondary to vascular invasion was referred for percutaneous IRE after he refused chemotherapy or radiation. Computed tomography (CT) imaging (Fig 1) revealed a 4.1 × 4.1 × 3.5-cm mass with encasement of the celiac axis and origin of the superior mesenteric artery and occlusion of the extrahepatic portal vein and superior mesenteric vein. A whole-body staging CT scan

Discussion

Pancreatic cancer was newly diagnosed in more than 40,000 patients in 2010, with 30% of patients presenting with surgically unresectable disease without metastatic disease (14). Primary therapeutic modalities for stage III pancreatic carcinoma are chemotherapy and radiation. The present report of successful ablation of locally advanced pancreatic cancer suggests that IRE may have a role in this location for local tumor control.

Encouraging results have also been reported with thermal ablation of

References (14)

There are more references available in the full text version of this article.

Cited by (71)

  • A prospective, multi-institution assessment of irreversible electroporation for treatment of locally advanced pancreatic adenocarcinoma: initial outcomes from the AHPBA pancreatic registry

    2019, HPB
    Citation Excerpt :

    This finding is consistent with previously-reported mortality rates between 0 and 2% regardless of surgical (open vs percutaneous) approach.11,23,25–27 With respect to morbidity, the present study, which demonstrates an overall adverse event rate of 18% overall and a severe (≥grade 3) adverse event rate of 13%, compares favorably with previous work reporting complication rates between 0 and 53%.7,9,10,18,23,28 As a result, it highlights the importance of a standardized IRE protocol for broad minimization of morbidity following the procedure.

  • Noninvasive detection of changes in cells’ cytosol conductivity by combining dielectrophoresis with optical tweezers

    2018, Analytica Chimica Acta
    Citation Excerpt :

    It is used in electrochemotherapy [10,11,12] and as a non-viral method of in vitro and in vivo gene delivery to cells (gene electrotransfer) [7,13]. Furthermore, electroporation as a stand-alone technique can be used for tumor ablation using the non-thermal irreversible electroporation [10,12,14–19]. In spite of its important applications, the cellular mechanisms of the electrically-induced increase in membrane permeability are still under debate, demanding detection of changes in cellular electrical properties during the electroporation process [20].

  • Percutaneous irreversible electroporation for treatment of locally advanced pancreatic cancer following chemotherapy or radiochemotherapy

    2016, European Journal of Surgical Oncology
    Citation Excerpt :

    With thermal ablation, there is also a risk that heat close to the vessels is insufficient to ablate all tumor cells, the so called heat-sink effect, especially since LAPC per definition include major vessels.4 Irreversible electroporation (IRE) is a non-thermal based ablation technique and is based on the transmission of short direct current pulses through the tumor via needles, leading to irreversible change in cell membrane integrity and subsequent apoptosis.5–9 A unique feature of IRE is that although some heat is generated collagen structures such as blood vessels and bile ducts are not destroyed.

View all citing articles on Scopus

This work was supported by the research department at the Inova Alexandria Hospital Cardiovascular and Interventional Radiology Department. Neither of the authors has identified a conflict of interest.

View full text