Abstract Title The Role of Irreversible Electroporation for Pancreatic Cancer

Background Pancreatic cancer is one of the most aggressive cancers in the world, representing the fourth most frequent tumor-related cause of death in the Western world and the seventh leading cause of cancer death worldwide. Surgical resection offers the only chance of long-term survival, but only 15-20% of patients have potentially resectable disease at primary diagnosis. Due to proximity to critical anatomical structures, patients with locally advanced pancreatic cancer (LAPC) may be unable to undergo surgical resection. Furthermore, many patients with LAPC are treated like metastatic disease with systemic palliative chemotherapy, resulting in poor response. The aim of the present review was to evaluate the role of irreversible electroporation (IRE) in borderline resectable pancreatic cancer and LAPC.

Methods A comprehensive review was performed using PubMed, Embase (OvidSP), Library of Congress, Lista (EBSCO), and Web of Science Core Collection. The initial search was conducted using the terms “Pancreatic Cancer” or “Pancreatic Adenocarcinoma” and “Irreversible Electroporation” in the title field, yielding 165 results. 140 articles were excluded because they focused on cancers not pertinent to the study, weren’t exclusive to human studies, combined open and percutaneous IRE data, or didn’t pertain to the study. The remaining 25 articles were examined for quality reporting data related to key inclusion materials, and 15 articles’ survival outcomes, safety, and efficacy results were included. The data extracted focused on outcomes related to progression free survival (PFS) and overall survival (OS) relating to IRE therapy, safety and efficacy compared to other ablation techniques, and induction chemotherapy regimen type and intensity. The primary endpoint was to determine whether IRE could safely and effectively improve PFS and OS in patients with LAPC.

Results IRE has demonstrated encouraging survival and response outcomes when combined with induction chemotherapy versus patient populations that receive chemotherapy and/or chemoradiation alone. The use of IRE with targeted therapies may enhance antitumor immunity and possibly improve survival outcomes compared to historical controls. Additionally, the combination of IRE with multiagent therapy has been associated with a low rate of serious adverse events, complications, and infections.

Conclusion Irreversible electroporation could improve overall survival and progression free survival when combined with multiagent therapy in patients with LAPC. The optimal management of patients with LAPC is evolving with the advent of improved IRE implementation, newer chemotherapeutics and immunotherapy. IRE has demonstrated itself to be a viable surgical intervention for patients with borderline resectable pancreatic cancer and LAPC.