Po-Chih Yang1, Kai-Wen Huang2, Uei Pua3, Man-Deuk Kim4, Sheng-Ping Li5, Xiao-Yong Li6, Po-Chin Liang7. 1. Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Surgery, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan. 2. Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Surgery & Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: skywing@ntuh.gov.tw. 3. Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore. 4. Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea. 5. Department of Hepatobiliary Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou, China. 6. Department of General Surgery, The 5th Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China. 7. Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
Abstract
INTRODUCTION: Irreversible electroporation (IRE) is a modality that utilizes high electric voltage to cause cell apoptosis. IRE has been used to treat locally advanced pancreatic cancer (LAPC). However, studies of IRE via surgical approaches for LAPC are limited. This study aims to analyse the outcomes and related prognostic factors of IRE for Asian patients with LAPC. MATERIALS AND METHODS: From 2012 to 2017, this prospective trial for using IRE through surgical approaches for LAPC was conducted in 11 medical centres in Asia. All related and treatment outcomes were analysed from a prospective database. RESULTS: Seventy-four patients were enrolled. Thirty complications occurred in thirteen (17.6%) patients without mortality. The electrode placement direction (anteroposterior vs. craniocaudal, HR = 14.2, p < 0.01) and gastrointestinal invasion (HR = 15.7, p < 0.01) were significant factors for complications. The progression-free survival (PFS) rate in one year, three years, and five years were 69.1%, 48.7%, and 28.8%, and the overall survival (OS) rate in one year, three years, and five years were 97.2%, 53%, and 31.2%. In univariate analysis, the chemotherapy regimen, local tumour recurrence, axial tumour length, tumour volume, and serum carbohydrate antigen 19-9 levels were all significantly associated with PFS and OS. In multivariate analysis, the chemotherapy regimen was the only significant factor associated with PFS and OS. TS-1 (Tegafur, gimeracil, and oteracil) group has superior survival outcome than gemcitabine group. CONCLUSION: This study showed that combined induction chemotherapy and surgical IRE for LAPC is safe. For well-selected patients, IRE can achieve encouraging survival outcomes.
INTRODUCTION: Irreversible electroporation (IRE) is a modality that utilizes high electric voltage to cause cell apoptosis. IRE has been used to treat locally advanced pancreatic cancer (LAPC). However, studies of IRE via surgical approaches for LAPC are limited. This study aims to analyse the outcomes and related prognostic factors of IRE for Asian patients with LAPC. MATERIALS AND METHODS: From 2012 to 2017, this prospective trial for using IRE through surgical approaches for LAPC was conducted in 11 medical centres in Asia. All related and treatment outcomes were analysed from a prospective database. RESULTS: Seventy-four patients were enrolled. Thirty complications occurred in thirteen (17.6%) patients without mortality. The electrode placement direction (anteroposterior vs. craniocaudal, HR = 14.2, p < 0.01) and gastrointestinal invasion (HR = 15.7, p < 0.01) were significant factors for complications. The progression-free survival (PFS) rate in one year, three years, and five years were 69.1%, 48.7%, and 28.8%, and the overall survival (OS) rate in one year, three years, and five years were 97.2%, 53%, and 31.2%. In univariate analysis, the chemotherapy regimen, local tumour recurrence, axial tumour length, tumour volume, and serum carbohydrate antigen 19-9 levels were all significantly associated with PFS and OS. In multivariate analysis, the chemotherapy regimen was the only significant factor associated with PFS and OS. TS-1 (Tegafur, gimeracil, and oteracil) group has superior survival outcome than gemcitabine group. CONCLUSION: This study showed that combined induction chemotherapy and surgical IRE for LAPC is safe. For well-selected patients, IRE can achieve encouraging survival outcomes.
Authors: Florentine E F Timmer; Bart Geboers; Sanne Nieuwenhuizen; Evelien A C Schouten; Madelon Dijkstra; Jan J J de Vries; M Petrousjka van den Tol; Tanja D de Gruijl; Hester J Scheffer; Martijn R Meijerink Journal: Curr Oncol Rep Date: 2021-04-17 Impact factor: 5.075