Repeated irreversible electroporation in a locally advanced pancreatic cancer

Abstract

It is reasonable to consider the technical possibility and oncological feasibility of the local tumor destruction in patients with locally advanced pancreatic cancer (PCa). Irreversible electroporation (IRE) is a non-thermal method of local tumor ablation, which uses non-thermal energy of high-voltage ultrashort electric fields localized between electrodes to create nanopores in the cellular wall with the following cellular death. The zone of impact can be accurately predicted using the location of the electrodes. A fairly clear and controlled ablation boundary without a clinically significant zone of perifocal tissue damage reduces the risk of accidental injury to the wall of a hollow organ. The method is based on a change in the permeability of the cell membrane and the development of apoptosis, which allows to act directly on the ducts and the great vessels infiltrated by the tumor without a high risk of damage. The presented case shows that IRE is advisable to use as a part of the combined treatment of patients with locally advanced PCa. There were no complications observed after the IRE. Radiological evaluations and pathologic reports showed an adequate long-term local control. Also, good results were obtained in the overall life expectancy, given that we are talking about unresectable ductal adenocarcinoma of the pancreas. The patient passed away in 39 months from the beginning of the treatment and in 26 months from the initial IRE. In case of local relapse, repeated electroporation with a good long-term result is also possible. The time to progression exceeded eleven months after electroporation performed for a local relapse. According to magnetic resonance imaging, both locoregional relapse and distant liver metastases were detected. The patient lived 16 months after a repeated IRE session and died of pulmonary embolism on the background of chemotherapy. Favorable prognostic factors are the presence of an objective response to previous conservative treatment, compliance with the parameters of electroporation, complete inclusion of tumor infiltration in the affected area.