E293: Irreversible Electroporation as a Potential Adjunct for Locally Advanced Pancreatic Cancer

Irreversible Electroporation (IRE) is a nonthermal ablative technology that uses short-duration electrical pulses to induce cell death, and its use as a treatment adjunct in locally advanced pancreatic ductal adenocarcinoma (PDAC) is increasing. However, there remains ongoing debate over its potential impact on patient survival. Our institution, a tertiary referral cancer center for pancreatic cancer, adopted the use of IRE in June 2020. We hypothesized that its utilization would lead to improved survival in patients with locally advanced PDAC.

Methods:

We retrospectively reviewed PDAC patients treated with IRE between 2020-2022. We compared overall survival to patients with resected PDAC and patients who were unresected but would have been eligible for IRE between 2010-2022. Resectability was defined by NCCN guidelines. All included patients had received neoadjuvant chemotherapy/chemoradiation. Among the unresected cohort, patients who experienced disease progression during the neoadjuvant phase were excluded. Modified log-rank test was used to assess survival differences.

Results:

Of 182 patients in the included cohort, 113 had resectable/borderline resectable disease and underwent resection alone, 12 had locally advanced disease managed with resection+IRE, 15 had locally advanced disease managed with IRE only, 15 had no resection for borderline resectable disease, and 27 had no resection for locally advanced disease. IRE patients had a median follow-up of 27 mos. [95% CI: 24-NR], while for non-IRE patients it was 33 mos. [95% CI: 29-40].  Median age and proportion without comorbidities did not significantly differ across all groups.  Nevertheless, median survival from diagnosis (Figure 1) was not reached (95% CI: 30-NR) for patients who underwent resection+IRE for locally advanced disease and was 30 mos. [95% CI: 27-60] for those who underwent resection alone for resectable/borderline resectable disease. Interestingly, median survival for those who underwent IRE alone was 28 mos. [95% CI: 16-NR]) and was comparable to those who underwent resection alone. Median survival for patients who underwent IRE was also better than those who had unresected borderline disease (12 mos. [95% CI: 9-NR], P=0.03) and unresected locally advanced disease (17 mos. [95% CI: 12-27], P</em>=0.07).

Conclusions:

Adjunctive use of IRE may enhance survival in patients with locally advanced PDAC, and adoption of this technology is feasible in high volume pancreatic centers. However, prospective studies are needed to confirm the potential benefits of this technology as an adjunct during pancreatic resection.