Irreversible electroporation for pancreatic cancer: Is it worth the hype?

Vikas Kumar Dudeja

doi:10.1016/j.pan.2016.06.140

Most patients with pancreatic cancer present with advanced disease and are not candidate for potentially curative resection. While majority have metastatic disease and are best served with systemic therapy, about 1/3rd present with locally advanced disease where tumor involves major vascular structures and is unresectable. Unfortunately induction chemotherapy for locally advanced disease seldom results in sufficient “downstaging” to enable potentially curative resection and these patients are relegated to long term systemic chemotherapy with or without radiotherapy. The use of local thermal ablative methods such as radiofrequency ablation and microwave ablation, in pancreatic tumors is limited by the risk of thermal damage to nearby blood vessels and bile ducts, and the heat sink effect with risk of under-ablation of the neighboring tumor cells. Irreversible electroporation (IRE) is a novel, non-thermal ablative technique where short pulses of high voltage low energy electric current delivered to the tissues result in the formation of nanoscale micropores in the lipid bilayer of cell membranes, which leads to cell swelling and death. Because it does not rely on thermal energy, it can be used near major blood vessels and vital structures thus making it well-suited for ablation of un-resectable pancreatic tumors. While IRE is being increasingly adopted for treatment of locally advanced un-resectable pancreatic, the data on its safety and efficacy is limited to small single institutional case series. Furthermore, IRE has received criticism as it involves use of loco-regional therapy for treatment of advanced pancreatic cancer which is considered to be associated with high risk of systemic failure. Diligent search for metastatic disease and neo-adjuvant chemotherapy to treat systemic disease before the procedure may help select patients who may benefit from this procedure. Multi-institutional trials are needed to generate more data and help delineate its role in the care of patients with this difficult disease.

Irreversible electroporation for pancreatic cancer: Is it worth the hype?

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