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Title: Percutaneous Irreversible Electroporation of Locally Advanced Pancreatic Carcinoma Using the Dorsal Approach: A Case Report

Abstract

Irreversible electroporation (IRE) is a novel image-guided ablation technique that is increasingly used to treat locally advanced pancreatic carcinoma (LAPC). We describe a 67-year-old male patient with a 5 cm stage III pancreatic tumor who was referred for IRE. Because the ventral approach for electrode placement was considered dangerous due to vicinity of the tumor to collateral vessels and duodenum, the dorsal approach was chosen. Under CT-guidance, six electrodes were advanced in the tumor, approaching paravertebrally alongside the aorta and inferior vena cava. Ablation was performed without complications. This case describes that when ventral electrode placement for pancreatic IRE is impaired, the dorsal approach could be considered alternatively.

Authors:
;  [1];  [2];  [1]; ;  [3];  [1]
  1. VU University Medical Center, Department of Radiology and Nuclear Medicine (Netherlands)
  2. Academic Medical Center, Department of Surgery (Netherlands)
  3. VU University Medical Center, Department of Surgery (Netherlands)
Publication Date:
OSTI Identifier:
22469938
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 38; Journal Issue: 3; Conference: CIRSE 2015: Cardiovascular and Interventional Radiological Society of Europe congress, Lisbon (Portugal), 26-30 Sep 2015; Other Information: Copyright (c) 2015 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ABLATION; AORTA; CARCINOMAS; COMPUTERIZED TOMOGRAPHY; ELECTRODES; IMAGES; MALES; PANCREAS; PATIENTS; SMALL INTESTINE; VEINS; WHO

Citation Formats

Scheffer, Hester J., E-mail: hj.scheffer@vumc.nl, Melenhorst, Marleen C. A. M., E-mail: m.melenhorst@vumc.nl, Vogel, Jantien A., E-mail: j.a.vogel@amc.uva.nl, Tilborg, Aukje A. J. M. van, E-mail: a.vantilborg@vumc.nl, Nielsen, Karin, E-mail: k.nielsen@vumc.nl, Kazemier, Geert, E-mail: g.kazemier@vumc.nl, and Meijerink, Martijn R., E-mail: mr.meijerink@vumc.nl. Percutaneous Irreversible Electroporation of Locally Advanced Pancreatic Carcinoma Using the Dorsal Approach: A Case Report. United States: N. p., 2015. Web. doi:10.1007/S00270-014-0950-X.
Scheffer, Hester J., E-mail: hj.scheffer@vumc.nl, Melenhorst, Marleen C. A. M., E-mail: m.melenhorst@vumc.nl, Vogel, Jantien A., E-mail: j.a.vogel@amc.uva.nl, Tilborg, Aukje A. J. M. van, E-mail: a.vantilborg@vumc.nl, Nielsen, Karin, E-mail: k.nielsen@vumc.nl, Kazemier, Geert, E-mail: g.kazemier@vumc.nl, & Meijerink, Martijn R., E-mail: mr.meijerink@vumc.nl. Percutaneous Irreversible Electroporation of Locally Advanced Pancreatic Carcinoma Using the Dorsal Approach: A Case Report. United States. doi:10.1007/S00270-014-0950-X.
Scheffer, Hester J., E-mail: hj.scheffer@vumc.nl, Melenhorst, Marleen C. A. M., E-mail: m.melenhorst@vumc.nl, Vogel, Jantien A., E-mail: j.a.vogel@amc.uva.nl, Tilborg, Aukje A. J. M. van, E-mail: a.vantilborg@vumc.nl, Nielsen, Karin, E-mail: k.nielsen@vumc.nl, Kazemier, Geert, E-mail: g.kazemier@vumc.nl, and Meijerink, Martijn R., E-mail: mr.meijerink@vumc.nl. Mon . "Percutaneous Irreversible Electroporation of Locally Advanced Pancreatic Carcinoma Using the Dorsal Approach: A Case Report". United States. doi:10.1007/S00270-014-0950-X.
@article{osti_22469938,
title = {Percutaneous Irreversible Electroporation of Locally Advanced Pancreatic Carcinoma Using the Dorsal Approach: A Case Report},
author = {Scheffer, Hester J., E-mail: hj.scheffer@vumc.nl and Melenhorst, Marleen C. A. M., E-mail: m.melenhorst@vumc.nl and Vogel, Jantien A., E-mail: j.a.vogel@amc.uva.nl and Tilborg, Aukje A. J. M. van, E-mail: a.vantilborg@vumc.nl and Nielsen, Karin, E-mail: k.nielsen@vumc.nl and Kazemier, Geert, E-mail: g.kazemier@vumc.nl and Meijerink, Martijn R., E-mail: mr.meijerink@vumc.nl},
abstractNote = {Irreversible electroporation (IRE) is a novel image-guided ablation technique that is increasingly used to treat locally advanced pancreatic carcinoma (LAPC). We describe a 67-year-old male patient with a 5 cm stage III pancreatic tumor who was referred for IRE. Because the ventral approach for electrode placement was considered dangerous due to vicinity of the tumor to collateral vessels and duodenum, the dorsal approach was chosen. Under CT-guidance, six electrodes were advanced in the tumor, approaching paravertebrally alongside the aorta and inferior vena cava. Ablation was performed without complications. This case describes that when ventral electrode placement for pancreatic IRE is impaired, the dorsal approach could be considered alternatively.},
doi = {10.1007/S00270-014-0950-X},
journal = {Cardiovascular and Interventional Radiology},
number = 3,
volume = 38,
place = {United States},
year = {Mon Jun 15 00:00:00 EDT 2015},
month = {Mon Jun 15 00:00:00 EDT 2015}
}
  • Irreversible electroporation (IRE) is a novel image-guided ablation technique that is rapidly gaining popularity in the treatment of malignant tumors located near large vessels or bile ducts. The presence of metal objects in the ablation zone, such as Wallstents, is generally considered a contraindication for IRE, because tissue heating due to power conduction may lead to thermal complications. This report describes a 66-year-old female with a Bismuth–Corlette stage IV unresectable cholangiocarcinoma with a metallic Wallstent in the common bile duct, who was safely treated with percutaneous IRE with no signs for relapse 1 year after the procedure.
  • PurposeThis study was designed to assess efficacy and safety in the treatment of perivascular malignant liver lesions using percutaneous, computed tomography (CT)-guided irreversible electroporation (IRE).MethodsFourteen patients (mean age 58 ± 11 years) with 18 malignant liver lesions were consecutively enrolled in this study. IRE was performed in patients not eligible for surgery and lesions abutting large vessels or bile ducts. Follow-up exams were performed using multislice-CT (MS-CT) or MRI.ResultsMedium lesion diameter was 20 ± 5 mm. Ten of 14 (71 %) were successfully treated with no local recurrence to date (mean follow-up 388 ± 160 days). One case left initial tumor control unclear and additional RFA was performed 4 weeks aftermore » IRE. Complications occurred in 4 of 14 (29 %) cases. In one case, intervention was terminated and abdominal bleeding required laparotomy. In two cases, a postinterventional hematothorax required intervention. In another case, abdominal bleeding could be managed conservatively. No complications related to the bile ducts occurred.ConclusionsPercutaneous IRE seems to be effective in perivascular lesions but is associated with a higher complication rate compared with thermoablative techniques.« less
  • Purpose: To perform an analysis of three-dimensional conformal radiation therapy (3D-CRT), sequential boost intensity-modulated radiation therapy (IMRTs), and integrated boost IMRT (IMRTi) for dose escalation in unresectable pancreatic carcinoma. Methods and Materials: Computed tomography images from 15 patients were used. Treatment plans were generated using 3D-CRT, IMRTs, and IMRTi for dose levels of 54, 59.4, and 64.8 Gy. Plans were analyzed for target coverage, doses to liver, kidneys, small bowel, and spinal cord. Results: Three-dimensional-CRT exceeded tolerance to small bowel in 1 of 15 (6.67%) patients at 54 Gy, and 4 of 15 (26.7%) patients at 59.4 and 64.8 Gy.more » 3D-CRT exceeded spinal cord tolerance in 1 of 15 patients (6.67%) at 59.4 Gy and liver constraints in 1 of 15 patients (6.67%) at 64.8 Gy; no IMRT plans exceeded tissue tolerance. Both IMRT techniques reduced the percentage of total kidney volume receiving 20 Gy (V20), the percentage of small bowel receiving 45 Gy (V45), and the percentage of liver receiving 35 Gy (V35). IMRTi appeared superior to IMRTs in reducing the total kidney V20 (p < 0.0001), right kidney V20 (p < 0.0001), and small bowel V45 (p = 0.02). Conclusions: Sequential boost IMRT and IMRTi improved the ability to achieve normal tissue dose goals compared with 3D-CRT. IMRTi allowed dose escalation to 64.8 Gy with acceptable normal tissue doses and superior dosimetry compared with 3D-CRT and IMRTs.« less
  • Objective: Irreversible electroporation (IRE) uses direct electrical pulses to create permanent 'pores' in cell membranes to cause cell death. In contrast to conventional modalities, IRE has a nonthermal mechanism of action. Our objective was to study the histopathological and imaging features of IRE in normal swine lung. Materials and Methods: Eleven female swine were studied for hyperacute (8 h), acute (24 h), subacute (96 h), and chronic (3 week) effects of IRE ablation in lung. Paired unipolar IRE applicators were placed under computed tomography (CT) guidance. Some applicators were deliberately positioned near bronchovascular structures. IRE pulse delivery was synchronized withmore » the cardiac rhythm only when ablation was performed within 2 cm of the heart. Contrast-enhanced CT scan was performed immediately before and after IRE and at 1 and 3 weeks after IRE ablation. Representative tissue was stained with hematoxylin and eosin for histopathology. Results: Twenty-five ablations were created: ten hyperacute, four acute, and three subacute ablations showed alveolar edema and necrosis with necrosis of bronchial, bronchiolar, and vascular epithelium. Bronchovascular architecture was maintained. Chronic ablations showed bronchiolitis obliterans and alveolar interstitial fibrosis. Immediate post-procedure CT images showed linear or patchy density along the applicator tract. At 1 week, there was consolidation that resolved partially or completely by 3 weeks. Pneumothorax requiring chest tube developed in two animals; no significant cardiac arrhythmias were noted. Conclusion: Our preliminary porcine study demonstrates the nonthermal and extracellular matrix sparing mechanism of action of IRE. IRE is a potential alternative to thermal ablative modalities.« less
  • Irreversible electroporation (IRE) is a novel image-guided ablation technique that is rapidly gaining popularity in the treatment of malignant liver tumors located near large vessels or bile ducts. We describe a 28-year-old female patient with a 5 cm large, centrally located hepatocellular adenoma who wished to get pregnant. Regarding the risk of growth and rupture of the adenoma caused by hormonal changes during pregnancy, treatment of the tumor was advised prior to pregnancy. However, due to its central location, the tumor was considered unsuitable for resection and thermal ablation. Percutaneous CT-guided IRE was performed without complications and led to rapid andmore » impressive tumor shrinkage. Subsequent pregnancy and delivery went uncomplicated. This case report suggests that the indication for IRE may extend to the treatment of benign liver tumors that cannot be treated safely otherwise.« less