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Pancreatic Adenocarcinoma Treated With Irreversible Electroporation Case Report: First Experience and Outcome.

Trueba-ArguiƱarena FJ, de Prado-Otero DS, Poves-Alvarez R - Medicine (Baltimore) (2015)

Bottom Line: This procedure is more costly than other techniques and is not free of complications.The percutaneous transgastric access is feasible and without serious complications.In our case, complications were resolved and the patient presented a good short/medium-term outcome.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Radiodiagnosis (FJT-A); Department of Oncology (DSDP-O); and Department of Anesthesia and Postoperative Care, University Clinical Hospital, Valladolid, Spain (RP-A).

ABSTRACT
Irreversible electroporation (IRE) is a new nonthermal tumor ablation modality that induces apoptosis in the treated tissue without affecting collagen. Its use is particularly indicated for tumors involving major structures, such as encompassed or infiltrated vessels and/or ducts, which need to be preserved and hinder or preclude surgical resection. We report a 66-year-old male patient with locally advanced pancreatic adenocarcinoma, treated with IRE.Two cycles of neoadjuvant chemotherapy with nab-paclitaxel and gemcitabine were administered. After these 2 cycles, IRE ablation was performed with a percutaneous transgastric access under general anesthesia. Later, 4 additional chemotherapy cycles were administrated. At 48 hours of electroporation, blood tests were normal. On day 5, a computed tomography (CT) scan showed portal vein and celiac artery were normal in appearance. Three months later, a positron emission tomography (PET) scan showed disappearance of abnormal uptake in the pancreas and other sites. A 12-month follow-up the patient is disease free.IRE opens a new way to treat tumors with involvement or proximity of neighboring structures. This procedure is more costly than other techniques and is not free of complications. The percutaneous transgastric access is feasible and without serious complications. In our case, complications were resolved and the patient presented a good short/medium-term outcome.

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Related in: MedlinePlus

A, CT scan (axial view) showing 2 of the needles placed at the ends of the tumor. B, CT scan (coronal view) showing the 6 needles placed at the edge of the tumor (arrows). C, CT scan 3D (superior view) showing the 6 needles placed.
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Figure 2: A, CT scan (axial view) showing 2 of the needles placed at the ends of the tumor. B, CT scan (coronal view) showing the 6 needles placed at the edge of the tumor (arrows). C, CT scan 3D (superior view) showing the 6 needles placed.

Mentions: After these 2 cycles, and after the informed consent of the patient, IRE ablation was performed percutaneously under balanced general anesthesia with sevoflurane, fentanyl, and deep neuromuscular blockade. Six needles were placed surrounding the tumor through an anterior transgastric approach under CT guidance (Figure 2), and 90 high-voltage pulses were applied between the needles.


Pancreatic Adenocarcinoma Treated With Irreversible Electroporation Case Report: First Experience and Outcome.

Trueba-ArguiƱarena FJ, de Prado-Otero DS, Poves-Alvarez R - Medicine (Baltimore) (2015)

A, CT scan (axial view) showing 2 of the needles placed at the ends of the tumor. B, CT scan (coronal view) showing the 6 needles placed at the edge of the tumor (arrows). C, CT scan 3D (superior view) showing the 6 needles placed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4504632&req=5

Figure 2: A, CT scan (axial view) showing 2 of the needles placed at the ends of the tumor. B, CT scan (coronal view) showing the 6 needles placed at the edge of the tumor (arrows). C, CT scan 3D (superior view) showing the 6 needles placed.
Mentions: After these 2 cycles, and after the informed consent of the patient, IRE ablation was performed percutaneously under balanced general anesthesia with sevoflurane, fentanyl, and deep neuromuscular blockade. Six needles were placed surrounding the tumor through an anterior transgastric approach under CT guidance (Figure 2), and 90 high-voltage pulses were applied between the needles.

Bottom Line: This procedure is more costly than other techniques and is not free of complications.The percutaneous transgastric access is feasible and without serious complications.In our case, complications were resolved and the patient presented a good short/medium-term outcome.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Radiodiagnosis (FJT-A); Department of Oncology (DSDP-O); and Department of Anesthesia and Postoperative Care, University Clinical Hospital, Valladolid, Spain (RP-A).

ABSTRACT
Irreversible electroporation (IRE) is a new nonthermal tumor ablation modality that induces apoptosis in the treated tissue without affecting collagen. Its use is particularly indicated for tumors involving major structures, such as encompassed or infiltrated vessels and/or ducts, which need to be preserved and hinder or preclude surgical resection. We report a 66-year-old male patient with locally advanced pancreatic adenocarcinoma, treated with IRE.Two cycles of neoadjuvant chemotherapy with nab-paclitaxel and gemcitabine were administered. After these 2 cycles, IRE ablation was performed with a percutaneous transgastric access under general anesthesia. Later, 4 additional chemotherapy cycles were administrated. At 48 hours of electroporation, blood tests were normal. On day 5, a computed tomography (CT) scan showed portal vein and celiac artery were normal in appearance. Three months later, a positron emission tomography (PET) scan showed disappearance of abnormal uptake in the pancreas and other sites. A 12-month follow-up the patient is disease free.IRE opens a new way to treat tumors with involvement or proximity of neighboring structures. This procedure is more costly than other techniques and is not free of complications. The percutaneous transgastric access is feasible and without serious complications. In our case, complications were resolved and the patient presented a good short/medium-term outcome.

Show MeSH
Related in: MedlinePlus