title: Percutaneous irreversible electroporation for downstaging and control of unresectable pancreatic adenocarcinoma.
abstract: OBJECTIVE
  Treatment of unresectable locally advanced pancreatic cancer (LAPC) usually includes chemotherapy and/or radiation therapy in an attempt to downstage these tumors to the extent of resectability, but outcomes remain poor. Irreversible electroporation (IRE) is an ablative modality that may be useful in this population. The aim of this study was to evaluate the safety of percutaneous IRE in patients with pancreatic adenocarcinoma.
  
  
  METHODS
  IRE was performed in patients with pancreatic cancer whose tumors remained unresectable after, or who were intolerant of, standard therapy. The procedures were all done percutaneously under general anesthesia. Patients were then followed for adverse events, tumor response, and survival.
  
  
  RESULTS
  Fifteen IRE procedures were performed in 14 patients (one was treated twice). Three patients had metastatic disease and 11 had LAPC. All patients had received chemotherapy previously, and 11 had received radiation. The median tumor size was 3.3 cm (range, 2.5-7 cm). Immediate and 24-hour postprocedural scans demonstrated patent vasculature in the treatment zone in all patients. Two patients underwent surgery 4 and 5 months after IRE, respectively. Both had margin-negative resections, and one had a pathologic complete response; both remain disease-free after 11 and 14 months, respectively. Complications included spontaneous pneumothorax during anesthesia (n = 1) and pancreatitis (n = 1), and both patients recovered completely. There were no deaths directly related to the procedure. All three patients with metastatic disease at IRE died from progression of their disease.
  
  
  CONCLUSIONS
  Percutaneous IRE for pancreatic adenocarcinoma is feasible and safe. A prospective trial is being planned.
authors.affiliation: Department of Radiology, Division of Vascular/Interventional Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, USA. gnarayanan@med.miami.edu
authors.forename: Govindarajan
authors.initials: G
authors.lastname: Narayanan
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hosein
authors.forename: Geetika
authors.initials: G
authors.lastname: Arora
authors.forename: Katuzka J
authors.initials: KJ
authors.lastname: Barbery
authors.forename: Tatiana
authors.initials: T
authors.lastname: Froud
authors.forename: Alan S
authors.initials: AS
authors.lastname: Livingstone
authors.forename: Dido
authors.initials: D
authors.lastname: Franceschi
authors.forename: Caio M
authors.initials: CM
authors.lastname: Rocha Lima
authors.forename: Jose
authors.initials: J
authors.lastname: Yrizarry
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000601:surgery*; D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D018274:Electroporation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D016896:Treatment Outcome