*Division of Surgical Oncology, Department of Surgery, and James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY †Department of Surgery, Henry Ford Hospital, Detroit, MI ‡Department of Surgery, Cleveland Clinic, Cleveland, OH §Department of Surgery, Piedmont Hospital, Atlanta, GA ¶Department of Surgery, Swedish Medical Center, Denver, CO; and ∥Cancer Treatment Centers of America, Atlanta, GA.
Ann Surg. 2015 Sep;262(3):486-94; discussion 492-4. doi: 10.1097/SLA.0000000000001441.
Ablative therapies have been increasingly utilized in the treatment of locally advanced pancreatic cancer (LAPC). Irreversible electroporation (IRE) is an energy delivery system, effective in ablating tumors by inducing irreversible membrane destruction of cells. We aimed to demonstrate efficacy of treatment with IRE as part of multimodal treatment of LAPC.
From July 2010 to October 2014, patients with radiographic stage III LAPC were treated with IRE and monitored under a multicenter, prospective institutional review board-approved registry. Perioperative 90-day outcomes, local failure, and overall survival were recorded.
A total of 200 patients with LAPC underwent IRE alone (n = 150) or pancreatic resection plus IRE for margin enhancement (n = 50). All patients underwent induction chemotherapy, and 52% received chemoradiation therapy as well for a median of 6 months (range, 5-13 months) before IRE. IRE was successfully performed in all patients. Thirty-seven percent of patients sustained complications, with a median grade of 2 (range, 1-5). Median length of stay was 6 days (range, 4-36 days). With a median follow-up of 29 months, 6 patients (3%) have experienced local recurrence. Median overall survival was 24.9 months (range: 4.9-85 months).
For patients with LAPC (stage III), the addition of IRE to conventional chemotherapy and radiation therapy results in substantially prolonged survival compared with historical controls. These results suggest that ablative control of the primary tumor may prolong survival.
消融疗法已越来越多地应用于局部晚期胰腺癌（LAPC）的治疗。不可逆电穿孔（IRE）是一种能量传递系统，通过诱导细胞不可逆的膜破坏，有效地消融肿瘤。我们旨在证明 IRE 在 LAPC 的多模态治疗中的治疗效果。
从 2010 年 7 月至 2014 年 10 月，对影像学 III 期 LAPC 患者进行 IRE 治疗，并在多中心、前瞻性机构审查委员会批准的登记处进行监测。记录围手术期 90 天的结果、局部失败和总生存率。
共有 200 例 LAPC 患者单独接受 IRE 治疗（n = 150）或胰腺切除术加 IRE 边缘增强（n = 50）。所有患者均接受诱导化疗，52%的患者还接受了放化疗，中位数为 6 个月（范围 5-13 个月），然后再进行 IRE。所有患者均成功进行了 IRE。37%的患者发生并发症，中位数为 2 级（范围 1-5 级）。中位住院时间为 6 天（范围 4-36 天）。中位随访 29 个月，6 例（3%）发生局部复发。中位总生存期为 24.9 个月（范围：4.9-85 个月）。
对于 LAPC（III 期）患者，与历史对照相比，IRE 联合常规化疗和放疗可显著延长生存时间。这些结果表明，对原发肿瘤的消融控制可能延长生存时间。
