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Systematic review of irreversible electroporation in the treatment of advanced pancreatic cancer

Lookup NU author(s): John Moir, Steven White, Jeremy French, Dr Peter Littler, Professor Derek Manas

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Abstract

Background: Irreversible electroporation (IRE) is a novel procedure to combat pancreatic cancer, whereby high voltage pulses are delivered, resulting in cell death. This represents an ideal alternative to other thermal treatment modalities, as there is no overriding heat effect, therefore reducing the risk, of injury to vessels and ducts.Methods: Multiple databases were searched to January 2014. Primary outcome measures were survival and associated morbidity. 41 articles were initially identified; of these 4 studies met the inclusion criteria, yielding 74 patients in total.Results: 94.5% of patients had locally advanced tumours, the remainder-had metastatic disease. Treated tumour size ranged from 1 to 7 cm. IRE approach included open (70.3%), laparoscopic (2.7%) and percutaneous (27%; ultrasound-guided 30%, CT-guided 70%) Morbidity ranged from 0 to 33%; due to the high number of simultaneous procedures performed (resection/bypass) it was difficult to ascertain IRE-related complications. However no significant bleeding occurred when IRE-alone was performed. Survival statistics suggest a prognostic benefit. Reported survival included: 6 month survival of 40% (n = 5) and 70% (n = 14); PFS and OS 14 and 20 months respectively (n = 54). Results of most interest showed a significant survival benefit in matched IRE vs non-IRE groups (PFS 14 vs 6 mths; p = 0.01, OS 20 vs 11 mths; p = 0.03).Conclusion: Initial evidence suggests IRE incurs a prognostic benefit with minimal morbidity. More high quality research is required to determine the role IRE may play in the multi-modal management of pancreatic cancers. (C) 2014 Elsevier Ltd. All rights reserved.


Publication metadata

Author(s): Moir J, White SA, French JJ, Littler P, Manas DM

Publication type: Review

Publication status: Published

Journal: European Journal of Surgical Oncology (EJSO)

Year: 2014

Volume: 40

Issue: 12

Pages: 1598-1604

Print publication date: 01/12/2014

Online publication date: 28/09/2014

Acceptance date: 26/08/2014

ISSN (print): 0748-7983

ISSN (electronic): 1532-2157

Publisher: ELSEVIER SCI LTD

URL: http://dx.doi.org/10.1016/j.ejso.2014.08.480

DOI: 10.1016/j.ejso.2014.08.480


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