title: Percutaneous CT-guided irreversible electroporation followed by chemotherapy as a novel neoadjuvant protocol in locally advanced pancreatic cancer: Our preliminary experience.
abstract: BACKGROUND
  Irreversible electroporation (IRE) is a non-thermal ablation technique recently used in pancreatic cancer. In our prospective study we evaluated safety, feasibility and efficacy of a neoadjuvant protocol based on CT-guided percutaneous IRE followed by chemotherapy in patients with locally advanced pancreatic cancer (LAPC).
  
  
  METHODS
  We performed CT-guided percutaneous IRE in 20 patients with LAPC, followed by a combination of gemcitabine (1000 mg/mq) and oxaliplatin (100 mg/mq) biweekly. Imaging follow-up was performed by a contrast enhanced CT scan at 1, 3, 6 months and then every 3 months.
  
  
  RESULTS
  No major complications occurred. Two patients died 3 and 4 months after IRE because of rapidly progressive disease. In the remaining 18 patients 6-month imaging follow-up showed a mean lesions volumetric decrease percentage of 42.89% (95% Confidence Interval: 34.90-54.88%). Thanks to lesions downstaging, three patients underwent R0 resection. At last available follow-up (mean follow-up 91 months; range 6-14), imaging showed no disease progression or post-surgical relapse in all 18 cases. The mean estimated survival was 12,950 months (95% CI: 11,570-14,332).
  
  
  CONCLUSIONS
  Our preliminary study suggests that IRE followed by chemotherapy is safe, feasible and effective in producing local control of LAPC, with a possible downstaging effect to resectable lesions.
authors.affiliation: Department of Clinical and Experimental Medicine, "F. Magrassi - A. Lanzara" Second University of Naples, Piazza Miraglia 2, 80131 Naples, Italy. Electronic address: mariapaolabelfiore@gmail.com.
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Belfiore
authors.affiliation: Department of Diagnostic Imaging, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy.
authors.forename: Francesco Michele
authors.initials: FM
authors.lastname: Ronza
authors.affiliation: Department of Informatics, Second University of Naples, Piazza Miraglia 2, 80131 Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Romano
authors.affiliation: Department of Oncology, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy.
authors.forename: Giovanni Pietro
authors.initials: GP
authors.lastname: Ianniello
authors.affiliation: Department of Oncology, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: De Lucia
authors.affiliation: Department of Anaesthesiology and Rianimation, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Gallo
authors.affiliation: Department of Anaesthesiology and Rianimation, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Marsicano
authors.affiliation: Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Piazza Miraglia 2, 80131 Naples, Italy.
authors.forename: Teresa Letizia
authors.initials: TL
authors.lastname: Di Gennaro
authors.affiliation: Department of Diagnostic Imaging, "S. Anna-S. Sebastiano" Hospital, Via F. Palasciano, 81100 Caserta, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Belfiore
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018274:Electroporation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000093542:Gemcitabine
keywords: Downstaging; Gemcitabine; IRE; Irreversible electroporation; Oxaliplatin; Pancreatic cancer