title: Percutaneous Image-Guided Irreversible Electroporation for the Treatment of Unresectable, Locally Advanced Pancreatic Adenocarcinoma.
abstract: OBJECTIVE
  To describe safety and effectiveness of percutaneous irreversible electroporation (IRE) for treatment of unresectable, locally advanced pancreatic adenocarcinoma (LAPC).
  
  
  METHODS
  This retrospective study included 50 patients (23 women, 27 men; age range, 46-91 y; median age, 62.5 y) with biopsy-proven, unresectable LAPC who received percutaneous computed tomography (CT)-guided IRE. The primary objective was to assess the safety profile of the procedure; the secondary objective was to determine overall survival (OS). All patients had prior chemotherapy (1-5 lines, median 2), and 30 (60%) of 50 patients had prior radiation therapy. Follow-up included CT at 1 month and at 3-month intervals thereafter.
  
  
  RESULTS
  There were no treatment-related deaths and no 30-day mortality. Serious adverse events occurred in 10 (20%) of 50 patients (abdominal pain [n = 7], pancreatitis [n = 1], sepsis [n = 1], gastric leak [n = 1]). Median OS was 27.0 months (95% confidence interval [CI], 22.7-32.5 months) from time of diagnosis and 14.2 months (95% CI, 9.7-16.2 months) from time of IRE. Patients with tumors ≤ 3 cm (n = 24) had significantly longer median OS than patients with tumors > 3 cm (n = 26): 33.8 vs 22.7 months from time of diagnosis (P = .002) and 16.2 vs 9.9 months from time of IRE (P = .031). Tumor size was confirmed as the only independent predictor of OS at multivariate analysis.
  
  
  CONCLUSIONS
  Percutaneous image-guided IRE of unresectable LAPC is associated with an acceptable safety profile.
authors.affiliation: Department of Interventional Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Avenue, C-080, Miami, FL 33136. Electronic address: gnarayanan@med.miami.edu.
authors.forename: Govindarajan
authors.initials: G
authors.lastname: Narayanan
authors.affiliation: Division of Medical Oncology, Department of Medicine, University of Kentucky, Lexington, Kentucky.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hosein
authors.affiliation: Department of Interventional Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Avenue, C-080, Miami, FL 33136.
authors.forename: Isabelle C
authors.initials: IC
authors.lastname: Beulaygue
authors.affiliation: Department of Interventional Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Avenue, C-080, Miami, FL 33136.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Froud
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Hester J
authors.initials: HJ
authors.lastname: Scheffer
authors.affiliation: Department of Interventional Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Avenue, C-080, Miami, FL 33136.
authors.forename: Shree R
authors.initials: SR
authors.lastname: Venkat
authors.affiliation: Department of Interventional Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Avenue, C-080, Miami, FL 33136.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Echenique
authors.affiliation: Department of Radiology, Jackson Memorial Hospital, Miami, Florida.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Hevert
authors.affiliation: Department of Medicine, Sylvester Comprehensive Cancer Center, and Department of Surgery, University of Miami Miller School of Medicine, 1475 NW 12th Avenue, C-080, Miami, FL 33136.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Livingstone
authors.affiliation: Division of Oncology, Gibbs Cancer Center & Research Institute, Spartanburg, South Carolina.
authors.forename: Caio M
authors.initials: CM
authors.lastname: Rocha-Lima
authors.affiliation: Division of Medical Oncology, University of Miami Miller School of Medicine, 1475 NW 12th Avenue, C-080, Miami, FL 33136.
authors.forename: Jaime R
authors.initials: JR
authors.lastname: Merchan
authors.affiliation: Department of Medicine, Sylvester Comprehensive Cancer Center, and Department of Surgery, University of Miami Miller School of Medicine, 1475 NW 12th Avenue, C-080, Miami, FL 33136.
authors.forename: Joseph U
authors.initials: JU
authors.lastname: Levi
authors.affiliation: Department of Interventional Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Avenue, C-080, Miami, FL 33136.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Yrizarry
authors.affiliation: Department of Interventional Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Avenue, C-080, Miami, FL 33136.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Lencioni
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D018274:Electroporation / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D016016:Proportional Hazards Models; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden