Outcomes of Irreversible Electroporation for Treatment of Refractory Locally Advanced Pancreatic Cancer

To evaluate the safety and effectiveness of irreversible electroporation (IRE) as salvage therapy for locally advanced pancreatic cancer (LAPC).

A retrospective cohort study was conducted of IRE performed by interventional radiologists or hepatopancreaticobiliary surgeons at a tertiary care institution for salvage treatment of LAPC. Procedures were performed between 2010 and 2024; 30 subjects (men, 18; women, 12; median age, 63.5 years) with biopsy-proven adenocarcinoma, evidence of vascular encasement, and progression on chemotherapy were included. Data were collected for patient demographics, prior treatments, tumor size, carbohydrate antigen (CA)19-9 levels, length of treatment stay, IRE treatment parameters, adverse events, posttreatment therapies, overall survival (OS), and progression-free survival (PFS).

Of 30 patients, 14 received percutaneous IRE and 16 received surgical IRE. Nine subjects received palliative surgery with IRE. OS was 11.4 months (IQR, 6-28 months). PFS was 7.6 months (IQR, 4-21 months). The overall adverse event rate was 33.3%. The serious adverse event rate was 12.1%. There was no association between survival or adverse event rate and age, tumor size, tumor location, or CA19-9 level. Moreover, 50% of subjects received additional treatment following IRE. OS for IRE with chemotherapy was 20.4 months. Outcome and adverse event rate were similar regardless of prior radiation treatment.

This study demonstrates that IRE may be a safe and effective option for salvage treatment of LAPC following chemotherapy and radiation.