Electrochemotherapy in locally advanced pancreatic cancer: Preliminary results.
OBJECTIVE
Report the preliminary results on electrochemotherapy (ECT) in the treatment of locally advanced pancreatic cancer of a phase I/II study and described the new functional imaging tools to assess ECT response in Magnetic Resonance (MR) imaging compared to morphological Computer Tomography (CT), ultrasound (US) without and with contrast enhancement (CEUS) and MR Imaging.


METHODS
Thirteen patients were enrolled in an ongoing clinical phase I/II study approved by Ethical Committee of National Cancer Institute G. Pascale Foundation - IRCCS of Naples. ECT with bleomycin was performed during open surgery. All patients underwent US and CT scan, before and after ECT treatment; 7 patients were evaluated using morphological and functional (dynamic contrast enhancement-DCE and diffusion weighted- DW) parameters in MR; 5 patients underwent CEUS. RECIST criteria were used to evaluate ECT response on US, CT and MR images. Functional parameters were also used to evaluate ECT response on MR images.


RESULTS
No acute (intraoperative) and/or postoperative serious adverse events related to electrochemotherapy were observed; no clinically significant electrocardiographic, hemodynamic, or serum biologic changes were noted. No clinically relevant elevation of amylase or lipase levels was observed and no bleeding or damage to surrounding viscera occurred. In three patients had seen splenic infarction without thrombosis of the splenic vessels.


CONCLUSIONS
Electrochemotherapy is feasible and safe treatment modality in patients with locally advanced pancreatic adenocarcinoma. Dynamic and diffusion MR imaging in comparison to MR morphological sequence alone and to UC and CT imaging is more suitable to assess ECT treatment response. CEUS is not indicated in follow up after ECT.
Diagnostic Imaging Department, "Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy.
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Granata
Diagnostic Imaging Department, "Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy.
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Fusco
Hepato-biliary Surgery Department, "Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy.
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Piccirillo
Hepato-biliary Surgery Department, "Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy.
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Palaia
Diagnostic Imaging Department, "Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy.
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Petrillo
Nuclear Medicine Department, "Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione Giovanni Pascale - IRCCS", Naples, Italy.
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Lastoria
Hepato-biliary Surgery Department, "Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy. Electronic address: f.izzo@istitutotumori.na.it.
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Izzo
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001761:Bleomycin / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D053672:Electrochemotherapy / Q000706:statistics & numerical data*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
D000903:Antibiotics, Antineoplastic; D009944:Organoplatinum Compounds; D003841:Deoxycytidine; D001761:Bleomycin; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
Electrochemotherapy; Pancreatic adenocarcinoma; Safety; Treatment assessment