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Treatment of 200 Locally Advanced (Stage III) Pancreatic Adenocarcinoma Patients With Irreversible Electroporation: Safety and Efficacy

Martin, Robert C. G. II MD, PhD, FACS*; Kwon, David MD, FACS; Chalikonda, Sricharan MD, FACS; Sellers, Marty MD, MPH, FACS§; Kotz, Eric MD; Scoggins, Charles MD, MBA, FACS*; McMasters, Kelly M. MD, PhD, FACS*; Watkins, Kevin MD, FACS

doi: 10.1097/SLA.0000000000001441
Papers of the 135th ASA Annual Meeting

Objectives: Ablative therapies have been increasingly utilized in the treatment of locally advanced pancreatic cancer (LAPC). Irreversible electroporation (IRE) is an energy delivery system, effective in ablating tumors by inducing irreversible membrane destruction of cells. We aimed to demonstrate efficacy of treatment with IRE as part of multimodal treatment of LAPC.

Methods: From July 2010 to October 2014, patients with radiographic stage III LAPC were treated with IRE and monitored under a multicenter, prospective institutional review board–approved registry. Perioperative 90-day outcomes, local failure, and overall survival were recorded.

Results: A total of 200 patients with LAPC underwent IRE alone (n = 150) or pancreatic resection plus IRE for margin enhancement (n = 50). All patients underwent induction chemotherapy, and 52% received chemoradiation therapy as well for a median of 6 months (range, 5–13 months) before IRE. IRE was successfully performed in all patients. Thirty-seven percent of patients sustained complications, with a median grade of 2 (range, 1–5). Median length of stay was 6 days (range, 4–36 days). With a median follow-up of 29 months, 6 patients (3%) have experienced local recurrence. Median overall survival was 24.9 months (range: 4.9–85 months).

Conclusions: For patients with LAPC (stage III), the addition of IRE to conventional chemotherapy and radiation therapy results in substantially prolonged survival compared with historical controls. These results suggest that ablative control of the primary tumor may prolong survival.

Supplemental Digital Content is Available in the Text.We aimed to demonstrate efficacy of treatment with Irreversible Electroporation as part of multimodal treatment of locally advanced pancreatic cancer. For patients with locally advanced pancreatic cancer (stage III), the addition of irreversible electroporation to conventional chemotherapy and radiation therapy results in substantially prolonged survival compared to historical controls. These results suggest that ablative control of the primary tumor may prolong survival.

*Division of Surgical Oncology, Department of Surgery, and James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY

Department of Surgery, Henry Ford Hospital, Detroit, MI

Department of Surgery, Cleveland Clinic, Cleveland, OH

§Department of Surgery, Piedmont Hospital, Atlanta, GA

Department of Surgery, Swedish Medical Center, Denver, CO; and

Cancer Treatment Centers of America, Atlanta, GA.

Reprints: Robert C. G. Martin, II, MD, PhD, FACS, University of Louisville, 315 East Broadway, Rm 313, Louisville, KY 40202. E-mail: Robert.martin@louisville.edu.

Presented at the 135th Annual Meeting of the American Surgical Association, April 23–25, 2015, San Diego, CA.

Disclosure: Partial support of the Soft Tissue Ablation Registry has come from an unrestricted educational grant from Angiodynamics. Drs Martin and Chalikonda are paid consultants for Angiodynamics. All other authors have nothing to declare.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).

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