Percutaneous irreversible electroporation in locally advanced pancreatic cancer – a review and a case report

Abstract

Background. The results of local destruction methods in locally advanced pancreatic cancer (LAPCa) are contradictory. Radiation therapy is the most commonly used. Other methods are used much less frequently, irreversible electroporation (IRE) is one of them. Most authors indicate an acceptable level of complications and mortality, but without an improvement in long-term results. The results of two meta-analyses have been published, the authors indicate the possibility of using the IRE in selected patients. The authors also point out that minimally invasive methods of using the IRE be preferred. Some experience has been gained in the use of percutaneous access for IRE in LAPCa. Computed tomography, ultrasound guidance can be used for navigation. The level of complications can reach 50 %. Mortality with percutaneous access, as a rule, is absent or does not exceed 5 %. Long-term results are the same with the results of open IRE.Aim. To share authors experience of using percutaneous irreversible electroporation in pancreatic cancer, because there are no references to the use of percutaneous IRE in LAPCa in Russia.Materials and methods. The IRE was performed for 53-year female patient with LAPCa after successful induction therapy. A step-by-step pulse effect of electrodes installed under ultrasound control on the tumor infiltrate was carried out. Magnetic resonance imaging, computed tomography and other types of studies were used for diagnostic purposes.Results. The involvement of the common hepatic artery and portal vein remained after the induction therapy, which did not allow performing pancreatoduodenal resection. Ultrasonic navigation and flat-detector computed tomography allowed to install the electrodes adequatly and safely. The impact zone almost completely blocked the infiltrate zone, a more optimal location of the electrodes was limited by the wide network of venous collaterals. Magnetic resonance imaging data performed before and after the procedure showed no progression of the disease within more than three months after the procedure, including in the affected area. Tumor shrinkage was noted as a partial response.Conclusion. The first experience confirmed the safety and the absence of subsequent complications when using the percutaneous access method of IRE for LAPCa. Follow-up monitoring of the patient will allow to say more correctly about the possibility of the method to provide long-term local control.