Anders K. Nilsson MD, PhD, Presenter: Nothing to Disclose

Christoffer Mansson MD, Abstract Co-Author: Nothing to Disclose

Brittmarie Karlson MD, PhD, Abstract Co-Author: Nothing to Disclose

To determine if irreversible electroporation (IRE) can be used in patients with locally advanced pancreatic cancer without too many serious adverse effects.

Between October 2011 and January 2014, 42 patients with locally advanced pancreatic cancer were treated with IRE, the primary goal being a locally complete ablation. All patients were discussed at a multidiciplinary conference and were determined to be unsuitable for surgery due to extensive vessel involvement and/or liver metastases. 3-6 IRE needles were placed in and around the tumour with distances not exceeding 20 mm. Active needle lengh was15 mm. Ablations were performed until 90 pulses had been delivered  between each relevant needle pair with a current of at least 30A. The aim was to create an ablation zone with a diameter of 4-5 cm. Clinical, laboratory and imaging data were recorded to detect complications.

Out of the 42 included patients, 27 no serious adverse effects. More serious complications occures in 15 patients (33%) and included duodenal perforation (1), bile duct perforation (1), bleeding (2), portal vein thrombosis (2) and pain requiring more than basic pain relief and diarrea (8). 1 patient developed a jaundice after the procedure and died during the subsequent ERCP.

Ultrasound guided percutaneous IRE ablations can be used in an attempt to achieve local tumour control in patients with locally advanced pancreatic cancer.The procedure offers a reasonable alternative when surgery is not possible but has a significant complication rate. The complications seem to be due to both the needle placement and the actual ablation.

IRE ablation in the region of the pancreatic head is possible without damage to vessels and other vulnerable structures and can therefore be attempted when surgery is not possible. Furthermore, as ablations in this area will affect arteries and veins as well as nerves, bile ducts, bowel walls and pancratic tissue, it can be seen as an indication that IRE can be used in other areas inaccessable to thermal ablations.

Nilsson, A, Mansson, C, Karlson, B, Percutaneous Ultrasound Guided Irreversible Electroporation in Locally Advanced Pancreatic Cancer: Short Term Complications.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14010298.html