The role of irreversible electroporation and other ablative techniques in patients with borderline resectable pancreatic cancer

Abstract

Initially diagnosed stage 3 (locally advanced) pancreatic adenocarcinoma (LAPC) remains an aggressive tumor with an overall poor prognosis (median survival of 9-12 months). Improvement in survival can be achieved in the small percentage that can undergo an R0 resection and in patients, where all macroscopic tumor can be cleared by local ablation techniques. Patients can have difficulty tolerating long durations of (>4-6 months) chemoradiotherapy, and this intervention alone still fails to prolong survival. Neoadjuvant treatment also has limited results on pain control or tumor downstaging since most current modalities do not shrink or downsize the tumor. In recent years, there has been a growing interest in the use of local ablative therapy for the treatment of non-resectable tumors in various organs. Ablation techniques are based on direct application of chemical, thermal, or electrical energy to a tumor, which leads to cellular necrosis without removal of the tumor. With ablation, both local control and relief from symptoms may be obtained in the majority of highly selected patients when appropriate technique is utilized. LAPC has been treated by various ablation techniques in the last few years with promising results. In this chapter, we will present the current status of local ablative therapies for the treatment of LAPC and discuss future trends.