Clinical Application Of CT-guided Percutaneous Irreversible Electroporation Ablation In Treatment Of Locally Advanced Pancreatic Cancer

PurposeTo investigate the therapeutic efficacy and safety of CT-guided percutaneous IRE ablation in treatment of LAPC prospectively, according to pre- and post- operative data(imaging and hematologic tests) combined with IRE ablation-related complications,OS and 1-year survival rate.Materials and MethodsAn institutional review board approved prospective study was started from July,2015 to December, 2016, including a total of 35 patients who were diagnosed with LAPC in our hospital. 20 (8males and 12femals, median age 59, 44-70) of them with 20 lesions were treated with CT-guided percutaneous IRE ablation. The median tumor size was 3.7cm (range, 2.2 -6.9) .Both pre- and post-procedure imagine (CT, MRI,PET-CT) as well blood baseline examinations were conducted, documented and compared relatively to evaluate the safety and efficacy of IRE ablation (post 3, 30, 90 and 365 days) as well as to reveal the superiorities of CT-guided percutaneous IRE ablation, and to explore the outcomes of this application of IRE ablation in improving living quality of patients.ResultsAll the procedures were completed successfully. Mean procedure time (2.6±0.74)h, postoperative enhanced CT scan performed immediately demonstrated an attenuation ablated area with presence of low-density air bubble surrounded cardinal structures like vasculature as well as pancreatic duct were free of damage. A transitory CA19-9 rising was founded in 19 patients, but decreased progressively within 3 days. One patient had a continuous high CA19-9 level, but there was no imaging evidence for recurrence. The postoperative 90-day dynamic imaging showed that 8 patients reached complete response (CR) ,8 accomplished partial response (PR) and 2 had stable disease (SD). 2 people died from serious gastrointestinal bleeding at 82- and 98-day after IRE ablation respectively. The 1-year survival rate after percutaneous IRE ablation in this cohort was 35%(with 12 had confirmed local recurrence). The median survival time of patients after IRE ablation was 329.5 days (10.9 months) . Common complications including slight nausea, vomit (n=4), peripancreatic exudation(n=3) (within 7 days post-procedure and disappeared gradually within 3 days), retroperitoneal infection(n=1), mesenteric(2 of 4) and portal (2 of 4) venous thrombosis, as well as duodenum stenosis(n=1) were founded. 2 patients had a temporary increase of heart rate accompanied with IRE pluses deliverance during the procedure. According to Clavien-Dindo criterion there are 4(20%) grade ? and 1 (5%) grade ?a complications within 30 days post-IRE. There is a notable decrease of analgesic dosage after IRE ablation.ConclusionCT-guided percutaneous IRE ablation is an accurate, minimal invasive, effective,and safe ablative approach. It has unique advantages beyond other traditional methods and has a promising clinical future in treatment of LAPC. With short treatment period,little damage, rapid recovery, and less side effects, CT-guided percutaneous IRE ablation also has prominent superiorities in patients with poor performance status,intolerance, and resistance of chemotherapy.