Abstract
Background
Locally advanced pancreatic cancer (LAPC) is usually treated with chemoradiotherapy with poor results. The aim of the study was to assess whether intraoperative electrochemotherapy could be proposed as additional therapy in treating LAPC.
Methods
Observational study of patients affected by LAPC who underwent intraoperative electrochemotherapy (ECT) after chemoradiotherapy. Data at diagnosis, at restaging and short and long-term outcomes, including assessment of quality of life, were collected for each patient.
Results
Five patients underwent ECT: in four cases, the tumours were located in the head and, in one, in the body of the pancreas. Preoperative chemotherapy consisted mainly of six cycles of modified Folfirinox. At restaging, the serum value of carbohydrate antigen (Ca 19–9) and tumour size were reduced; however, the vascular involvement did not change. No downstaging was recorded. The ECT procedure was performed using at least four needles with a mean duration time of 27 min (range 15–40). No postoperative mortality or major complications were reported. The mean length of stay (LOS) was 8 days (range 5–14). Four patients were alive and well at the end of the study, while one patient died from disease progression. The mean follow-up was 20.8 months (range 9–34) from diagnosis and 9.4 months (range 2–19) from ECT. The quality of life was good and there was improvement in pain/discomfort.
Conclusions
Electrochemotherapy could be proposed as a simple, feasible and safe palliative additional treatment in LAPC without progression after chemoradiotherapy. It seems to allow a good quality of life and pain improvement.
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References
Chan KKW, Guo H, Cheng S et al (2020) Real-world outcomes of FOLFIRINOX vs gemcitabine and nab-paclitaxel in advanced pancreatic cancer: a population-based propensity score-weighted analysis. Cancer Med 9:160–169
Suker M, Nuyttens JJ, Koerkamp BG et al (2018) FOLFIRINOX and radiotherapy for locally advanced pancreatic cancer: a cohort study. J Surg Oncol 118:1021–1026
Girelli R, Frigerio I, Salvia R et al (2010) Feasibility and safety of radiofrequency ablation for locally advanced pancreatic cancer. Br J Surg 97:220–225
Paiella S, De Pastena M, D’Onofrio M et al (2018) Palliative therapy in pancreatic cancer-interventional treatment with radiofrequency ablation/irreversible electroporation. Transl Gastroenterol Hepatol 3:80–88
Jaroszeski MJ, Gilbert RA, Heller R (1997) In vivo antitumor effects of electrochemotherapy in a hepatoma model. Bioch Biophis Acta 1334:15–18
Jaroszeski MJ, Dang V, Pottinger C et al (2000) Toxicity of anticancer agents mediated by electroporation in vitro. Anticancer Drugs 11:201–208
Granata V, Fusco R, Piccirillo M et al (2014) Feasibility and safety of intraoperative electrochemotherapy in locally advanced pancreatic tumors: a preliminary experience. Eur J Inflamm 12:467–477
Granata V, Fusco R, Piccirillo M et al (2015) Electrochemotherapy in locally advanced pancreatic cancer: preliminary results. Int J Surg 18:230–236
Girelli R, Prejanò S, Cataldo I et al (2015) Feasibility and safety of electrochemotherapy (ECT) in the pancreas: a pre-clinical investigation. Radiol Oncol 49:147–154
Bimonte S, Leongito M, Granata V et al (2016) Electrochemotherapy in pancreatic adenocarcinoma treatment: pre-clinical and clinical studies. Radiol Oncol 50:14–20
National Comprehensive Cancer Network (NCCN) (2020) Clinical practice guidelines in oncology. Pancreatic adenocarcinoma. Version 1.2020-November 26, 2019. NCCN.org.
Phelip JM, Edeline J, Blanc JF et al (2019) Modified FOLFIRINOX versus CisGem first-line chemotherapy for locally advanced non resectable or metastatic biliary tract cancer (AMEBICA)-PRODIGE 38: Study protocol for a randomized controlled multicenter phase II/III study. Dig Liv Dis 51:318–320
Takano N, Yamada S, Hirakawa A et al (2019) Phase II study of chemoradiotherapy combined with gemcitabine plus nab-paclitaxel for unresectable locally advanced pancreatic ductal adenocarcinoma (NUPAT 05 Trial): study protocol for a single arm phase II study. Nagoya J Med Sci 81:233–239
Self-Reported Population Health. (2014) An international perspective based on EQ-5D. In: Szende A, Janssen B, Cabases J (eds) Springer, London.
Dhir M, Malhotra GK, Sohal DPS et al (2017) Neoadjuvant treatment of pancreatic adenocarcinoma: a systematic review and meta-analysis of 5520 patients. World J Surg Oncol 15:183–191
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RC, wrote and drawed study, performed surgery; CR, wrote and drawed study, performed surgery; CI, patients enrollment; LA, patients enrollment; MDM, performed chemotherapy; AG, performed radiotherapy; FM, performed surgery and supervision of the paper; CS, performed procedure.
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Riccardo Casadei and all the other authors declare that they have no conflict of interest.
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This research involved only human participants and was in accordance with the 1964 Helsinky Declaration.
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Patient informed consent was obtained from each patient.
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Data reported are available, included in our database of pancreatic cancer.
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N.64/2017/U/Oss.
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Casadei, R., Ricci, C., Ingaldi, C. et al. Intraoperative electrochemotherapy in locally advanced pancreatic cancer: indications, techniques and results—a single-center experience. Updates Surg 72, 1089–1096 (2020). https://doi.org/10.1007/s13304-020-00782-x
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DOI: https://doi.org/10.1007/s13304-020-00782-x