Maria Paola Belfiore1, Francesco Michele Ronza2, Francesco Romano3, Giovanni Pietro Ianniello4, Guido De Lucia4, Concetta Gallo5, Carmela Marsicano5, Teresa Letizia Di Gennaro6, Giuseppe Belfiore2. 1. Department of Clinical and Experimental Medicine, "F. Magrassi - A. Lanzara" Second University of Naples, Piazza Miraglia 2, 80131 Naples, Italy. Electronic address: mariapaolabelfiore@gmail.com. 2. Department of Diagnostic Imaging, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy. 3. Department of Informatics, Second University of Naples, Piazza Miraglia 2, 80131 Naples, Italy. 4. Department of Oncology, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy. 5. Department of Anaesthesiology and Rianimation, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy. 6. Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Piazza Miraglia 2, 80131 Naples, Italy.
Abstract
INTRODUCTION: Irreversible electroporation (IRE) is a non-thermal ablation technique recently used in pancreatic cancer. In our prospective study we evaluated safety, feasibility and efficacy of a neoadjuvant protocol based on CT-guided percutaneous IRE followed by chemotherapy in patients with locally advanced pancreatic cancer (LAPC). METHODS: We performed CT-guided percutaneous IRE in 20 patients with LAPC, followed by a combination of gemcitabine (1000 mg/mq) and oxaliplatin (100 mg/mq) biweekly. Imaging follow-up was performed by a contrast enhanced CT scan at 1, 3, 6 months and then every 3 months. RESULTS: No major complications occurred. Two patients died 3 and 4 months after IRE because of rapidly progressive disease. In the remaining 18 patients 6-month imaging follow-up showed a mean lesions volumetric decrease percentage of 42.89% (95% Confidence Interval: 34.90-54.88%). Thanks to lesions downstaging, three patients underwent R0 resection. At last available follow-up (mean follow-up 91 months; range 6-14), imaging showed no disease progression or post-surgical relapse in all 18 cases. The mean estimated survival was 12,950 months (95% CI: 11,570-14,332). CONCLUSIONS: Our preliminary study suggests that IRE followed by chemotherapy is safe, feasible and effective in producing local control of LAPC, with a possible downstaging effect to resectable lesions.
INTRODUCTION: Irreversible electroporation (IRE) is a non-thermal ablation technique recently used in pancreatic cancer. In our prospective study we evaluated safety, feasibility and efficacy of a neoadjuvant protocol based on CT-guided percutaneous IRE followed by chemotherapy in patients with locally advanced pancreatic cancer (LAPC). METHODS: We performed CT-guided percutaneous IRE in 20 patients with LAPC, followed by a combination of gemcitabine (1000 mg/mq) and oxaliplatin (100 mg/mq) biweekly. Imaging follow-up was performed by a contrast enhanced CT scan at 1, 3, 6 months and then every 3 months. RESULTS: No major complications occurred. Two patients died 3 and 4 months after IRE because of rapidly progressive disease. In the remaining 18 patients 6-month imaging follow-up showed a mean lesions volumetric decrease percentage of 42.89% (95% Confidence Interval: 34.90-54.88%). Thanks to lesions downstaging, three patients underwent R0 resection. At last available follow-up (mean follow-up 91 months; range 6-14), imaging showed no disease progression or post-surgical relapse in all 18 cases. The mean estimated survival was 12,950 months (95% CI: 11,570-14,332). CONCLUSIONS: Our preliminary study suggests that IRE followed by chemotherapy is safe, feasible and effective in producing local control of LAPC, with a possible downstaging effect to resectable lesions.
Authors: Robert J S Coelen; Jantien A Vogel; Laurien G P H Vroomen; Eva Roos; Olivier R C Busch; Otto M van Delden; Foke van Delft; Michal Heger; Jeanin E van Hooft; Geert Kazemier; Heinz-Josef Klümpen; Krijn P van Lienden; Erik A J Rauws; Hester J Scheffer; Henk M Verheul; Jan de Vries; Johanna W Wilmink; Barbara M Zonderhuis; Marc G Besselink; Thomas M van Gulik; Martijn R Meijerink Journal: BMJ Open Date: 2017-09-01 Impact factor: 2.692