Early outcomes of irreversible electroporation after stereotactic body radiation therapy for the treatment of locally advanced pancreatic adenocarcinoma (LAPC): A matched pair analysis.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 410-410
Author(s):  
Emanuel Boyer ◽  
Russell Palm ◽  
Jessica M. Frakes ◽  
Sarah E. Hoffe ◽  
Mokenge Peter Malafa
Keyword(s):  
Pancreatic Cancer ◽  
Radiation Therapy ◽  
Pancreatic Adenocarcinoma ◽  
Cohort Analysis ◽  
Locally Advanced ◽  
Irreversible Electroporation ◽  
Advanced Pancreatic Cancer ◽  
Matched Pair ◽  
Optimal Timing ◽  
Entire Cohort

410 Background: Outcomes remain poor for those diagnosed with unresectable pancreatic cancer. SBRT and IRE have independently demonstrated high rates of local control and minimal toxicity for patients with locally advanced pancreatic cancer (LAPC). Data is limited regarding safety and efficacy in the sequential use of both therapies. Materials and Methods: A single institution retrospective matched cohort analysis was performed for patients with non-metastatic pancreatic cancer treated with induction chemotherapy and SBRT followed by IRE, compared with patients of the same cohort who did not receive IRE. Patients were paired based on age, tumor stage, GTV D95, CA19-9 prior to SBRT, and chemotherapy type to mitigate selection bias in surgical candidates. Overall survival (OS), progression free survival (PFS), freedom from local failure (FFLF) and freedom from distant failure (FFDF) were the primary outcomes compared via Kaplan-Meier survival analysis with log-rank methods. Results: From July, 2014 to February, 2020 17 patients received SBRT followed by IRE. These patients were matched with 17 patients who received SBRT from January, 2012 to March, 2019. Most patients received neoadjuvant FOLFIRINOX (82.4%) and were AJCC 8 stage III (79.4%). Median age of the overall cohort was 65.5 years and 50% were male. Median dose delivered to 95% of gross tumor volume was 32.61 Gy, and median pre SBRT CA19-9 value was 70.5 U/mL. There were no statistically significant differences in matched characteristics between the two cohorts. Among the SBRT+IRE, the median time between IRE and SBRT was 66 days (range:49-467 days). The median OS, PFS, FFLF, and FFDF for IRE+SBRT vs. SBRT alone from SBRT was 10.8 vs 15.1 months, 9.6 vs. 15.3 months, 15.7 vs. 15.3 months, 15.9 vs. 14.4 months respectively (all P > .10). 11 patients in the entire cohort experienced toxicity as a result of their radiation therapy (35%), with one G3 GIB and one patient experiencing G3 abdominal pain. Among the 17 patients who underwent IRE, nine patients experienced toxicity (53%). Most of these events were G3, with two G4 intestinal bleeds. There was zero mortality in the 90 day period post operatively. Conclusions: In a retrospective cohort,non-selective delivery ofIRE afterSBRT demonstrated no oncological benefit for patients with unresectable pancreatic adenocarcinoma compared to only SBRT. Compared to historical experiences of IRE alone, there was no increase in overall toxicity with the combination of SBRT and IRE. The optimal timing, sequencing, and indications for IRE and SBRT in LAPC remain unknown and are best assessed prospectively. [Table: see text]

scholarly journals Irreversible electroporation for pancreatic cancer using intraprocedural cone-beam computed tomography fusion navigation: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Sriram Rao ◽  
Thanh-Lan Bui ◽  
Ali Sasani ◽  
Ben Sadeghi ◽  
Anvesh Macherla ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pancreatic Cancer ◽  
Radiation Therapy ◽  
Cone Beam Computed Tomography ◽  
Locally Advanced ◽  
Irreversible Electroporation ◽  
Advanced Pancreatic Cancer ◽  
Locally Advanced Pancreatic Cancer ◽  
Cone Beam ◽  
Vascular Involvement

Abstract Background Patients diagnosed with locally advanced pancreatic cancer are usually not eligible for surgical resection because of significant vascular involvement. Stereotactic body radiation therapy and chemotherapy are the treatments recommended by the National Comprehensive Cancer Network criteria. For patients who do not respond to or tolerate stereotactic body radiation therapy and/or chemotherapy, a new option is irreversible electroporation. Irreversible electroporation is a nonthermal minimally invasive ablation technique that uses electrical pulses to induce apoptosis of tumor cells without damage to the extracellular matrix, thus preserving ducts and vessels. Irreversible electroporation requires very precise needle placement, which has limited its ubiquitous use. Intraprocedural cone-beam computed tomography with navigation can be fused with previous imaging to provide real-time tumor navigation capabilities during the procedure to allow for more accurate needle placement and treatment. Here, we present a patient who underwent percutaneous irreversible electroporation with intraprocedural cone-beam computed tomography fusion guidance to treat his pancreatic cancer. Case presentation The patient, an 88-year-old White male, initially presented with abdominal pain, and was ultimately diagnosed with locally advanced pancreatic cancer. He has an excellent performance status and no other comorbidities. He was started on chemotherapy and radiation therapy, with good response. However, continued vascular involvement of the tumors precluded him from safe surgical resection. The patient underwent irreversible electroporation with intraprocedural cone-beam computed tomography fusion navigation. The primary lesion demonstrates no residual tumor, and the soft tissue involvement of the adjacent vasculature has stabilized. Conclusions Although not curative on its own, irreversible electroporation holds promise as a treatment option for patients with locally advanced pancreatic cancer to increase downsizing to curative surgery or increase quality of life. Cone-beam computed tomography navigation can improve irreversible electroporation by providing guidance during needle guidance. Image fusion with previous advanced imaging can improve lesion visualization and targeting, thereby improving the effectiveness of irreversible electroporation.

Survival outcomes in the modern era for localized pancreatic cancer with multi-agent chemotherapy and stereotactic body radiation therapy.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 444-444 ◽  
Author(s):  
Shuchi Sehgal ◽  
Colin Hill ◽  
Wei Fu ◽  
Chen Hu ◽  
Amy Hacker-Prietz ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Performance Status ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Survival Outcomes ◽  
Entire Cohort ◽  
Stereotactic Body Radiation ◽  
Initial Biopsy

444 Background: The benefit of stereotactic body radiation therapy (SBRT) in the neoadjuvant setting for patients with localized pancreatic adenocarcinoma (PDAC) remains an area of active investigation. Herein, we report on surgical, pathologic, and survival outcomes in a modern cohort of borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) patients (pts) who were treated at a high-volume institution with upfront chemotherapy (CTX) followed by SBRT. Methods: A prospectively collected institutional IRB-approved database was reviewed to identify PDAC pts diagnosed between 2015-2018. All pts were seen in our multidisciplinary clinic and treated with multiagent induction CTX followed by 5-fraction SBRT. In general, it was our institutional preference that ECOG 0-1 pts were recommended modified FOLFIRINOX (mFFX), whereas others were recommended gemcitabine/abraxane. Pathological outcomes by stage were characterized. Kaplan-Meier analysis was used to generate survival curves, and factors prognostic for survival were identified. Results: Our cohort consisted of 156 pts, including 92 LAPC pts (59%) and 63 BRPC pts (41%). Median follow-up from diagnosis was 21.0 months (range 4-49 mos). Of the entire cohort, 117 (75%) received mFFX and 37 (24%) received gemcitabine/abraxane. Median duration of upfront CTX before SBRT was 4.0 months, with 126 pts (80.8%) receiving greater than 4 months. After SBRT, 130 pts (84%) were surgically explored with 106 pts (68%) successfully resected. Of 106 pts who were resected, 97 pts (92%) achieved negative margins, 63 pts (59%) were node-negative, and eight pts (8%) achieved a pathological complete response (pCR). Among 63 BRPC pts, 49 pts (78%) underwent resection, of whom 47 pts (96%) achieved margin negative resection. Among 92 LAPC pts, 57 pts (62%) underwent resection, of whom 50 pts (88%) achieved margin negative resection. For the entire cohort, median overall survival (mOS) from diagnosis was 25.4 mos (95% CI: 22.2 to NR) and 17.6 mos from SBRT (95% CI: 16.1 to NR). ECOG 0-1, initial biopsy grade (well-to-moderately differentiated), duration of neaodjuvant CTX (≥ 4 mos), surgical resection, and receipt of adjuvant CTX were all associated with improved survival from diagnosis (all p < 0.05), but stage (BR vs. LAPC) was not ( p = 0.43). Conclusions: In a modern cohort of patients receiving mFFX (75%) followed by SBRT, a high proportion of pts were successfully resected with favorable pathologic outcomes. Interestingly, OS was not significantly different for BRPC vs LAPC. Factors that proved to be important with respect to OS included duration of neoaduvant CTX, performance status, initial biopsy grade, and receipt of adjuvant CTX, After maximal multiagent CTX, factors other than stage should be considered in determining which pts will benefit from SBRT and/or subsequent surgery.

scholarly journals Irreversible Electroporation (IRE) in Locally Advanced Pancreatic Cancer: A Review of Current Clinical Outcomes, Mechanism of Action and Opportunities for Synergistic Therapy

2021 ◽  
Vol 10 (8) ◽  
pp. 1609
Author(s):  
Zainab L. Rai ◽  
Roger Feakins ◽  
Laura J. Pallett ◽  
Derek Manas ◽  
Brian R. Davidson
Keyword(s):  
Pancreatic Cancer ◽  
Mechanism Of Action ◽  
Locally Advanced ◽  
Irreversible Electroporation ◽  
Advanced Pancreatic Cancer ◽  
Standard Of Care ◽  
Locally Advanced Pancreatic Cancer ◽  
Animal Data ◽  
Standard Of Care Treatment ◽  
Apoptosis And Necrosis

Locally advanced pancreatic cancer (LAPC) accounts for 30% of patients with pancreatic cancer. Irreversible electroporation (IRE) is a novel cancer treatment that may improve survival and quality of life in LAPC. This narrative review will provide a perspective on the clinical experience of pancreas IRE therapy, explore the evidence for the mode of action, assess treatment complications, and propose strategies for augmenting IRE response. A systematic search was performed using PubMed regarding the clinical use and safety profile of IRE on pancreatic cancer, post-IRE sequential histological changes, associated immune response, and synergistic therapies. Animal data demonstrate that IRE induces both apoptosis and necrosis followed by fibrosis. Major complications may result from IRE; procedure related mortality is up to 2%, with an average morbidity as high as 36%. Nevertheless, prospective and retrospective studies suggest that IRE treatment may increase median overall survival of LAPC to as much as 30 months and provide preliminary data justifying the well-designed trials currently underway, comparing IRE to the standard of care treatment. The mechanism of action of IRE remains unknown, and there is a lack of data on treatment variables and efficiency in humans. There is emerging data suggesting that IRE can be augmented with synergistic therapies such as immunotherapy.

The role of radiotherapy in locally advanced pancreatic cancer

2021 ◽  
pp. 20210044
Author(s):  
Florence Huguet ◽  
Victoire Dabout ◽  
Eleonor Rivin del Campo ◽  
Sébastien Gaujoux ◽  
Jean Baptiste Bachet
Keyword(s):  
Pancreatic Cancer ◽  
Radiation Therapy ◽  
Technical Progress ◽  
Vascular Invasion ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Metastatic Tumour ◽  
Borderline Resectable ◽  
Made In

At diagnosis, about 15% of patients with pancreatic cancer present with a resectable tumour, 50% have a metastatic tumour, and 35% a locally advanced tumour, non-metastatic but unresectable due to vascular invasion, or borderline resectable. Despite the technical progress made in the field of radiation therapy and the improvement of the efficacy of chemotherapy, the prognosis of these patients remains very poor. Recently, the role of radiation therapy in the management of pancreatic cancer has been much debated. This review aims to evaluate the role of radiation therapy for patients with locally advanced tumours.

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