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Pancreas IRE

Michail Papamichail, Amir Ali, Michail Pizanias, Praveen Peddu, John Karani, Nigel Heaton
BACKGROUNDS/AIMS: Resection or enucleation is currently the treatment of choice for small pancreatic neuroendocrine tumors (NETs). Irreversible electroporation is a novel ablative method that is used for locally advanced pancreatic adenocarcinoma, but little data exists for its use for pancreatic NETs. We report an early experience of IRE for early pancreatic NETs. METHODS: Between April 2014 and March 2015, 3 patients with small (<2 cm) pancreatic NETs were treated with percutaneous IRE...
August 2016: Korean Journal of Hepato-biliary-pancreatic Surgery
Robert C G Martin, Alan North Durham, Marc G Besselink, David Iannitti, Matthew J Weiss, Christopher L Wolfgang, Kai-Wen Huang
Irreversible Electroporation (IRE) is used to treat locally advanced cancers, commonly of the pancreas, liver, kidney, and other soft tissues. Precise eligibility for IRE should be established in each individual patient by a multidisciplinary team based on comprehensive clinical, imaging, and laboratory assessment. Standardization of IRE technique and protocols is expected to improve safety, lead to reproducible outcomes, and facilitate further research into IRE. The present article provides a set of technical recommendations for the use of IRE in the treatment of locally advanced pancreatic cancer...
August 21, 2016: Journal of Surgical Oncology
Neal Bhutiani, Steven Agle, Yan Li, Suping Li, Robert C G Martin
INTRODUCTION: Irreversible electroporation (IRE) utilizes short, high-voltage pulses to irreversibly permeabilize the cell membrane, resulting in apoptotic cell death. In addition to the irreversible zone, IRE creates a reversible zone that could be utilized for enhanced drug delivery. The hypothesis of this study is that a zone of reversible electroporation exists and allows for increased chemotherapy delivery. METHODS: Ten immunocompromised mice with orthotopic human pancreatic adenocarcinoma tumors (Panc1) were treated with either IRE between two doses of gemcitabine (15 mg/kg) (ECT) (N = 5) or gemcitabine alone (N = 5)...
August 2016: Journal of Surgical Oncology
Peter Gk Wagstaff, Mara Buijs, Willemien van den Bos, Daniel M de Bruin, Patricia J Zondervan, Jean Jmch de la Rosette, M Pilar Laguna Pes
The field of focal ablative therapy for the treatment of cancer is characterized by abundance of thermal ablative techniques that provide a minimally invasive treatment option in selected tumors. However, the unselective destruction inflicted by thermal ablation modalities can result in damage to vital structures in the vicinity of the tumor. Furthermore, the efficacy of thermal ablation intensity can be impaired due to thermal sink caused by large blood vessels in the proximity of the tumor. Irreversible electroporation (IRE) is a novel ablation modality based on the principle of electroporation or electropermeabilization, in which electric pulses are used to create nanoscale defects in the cell membrane...
2016: OncoTargets and Therapy
Michael Linecker, Thomas Pfammatter, Patryk Kambakamba, Michelle L DeOliveira
With the advent of novel and somewhat effective chemotherapy against pancreas cancer, several groups developed a new interest on locally advanced pancreatic cancer (LAPC). Unresectable tumors constitute up to 80% of pancreatic cancer (PC) at the time of diagnosis and are associated with a 5-year overall survival of less than 5%. To control those tumors locally, with perhaps improved patients survival, significant advances were made over the last 2 decades in the development of ablation methods including cryoablation, radiofrequency ablation, microwave ablation, high intensity focused ultrasound and irreversible electroporation (IRE)...
2016: Digestive Surgery
Mateusz Wichtowski, Piotr Nowaczyk, Jacek Kocur, Dawid Murawa
AIM OF THE STUDY: Irreversible electroporation is a new, non-thermal ablation technique in the treatment of parenchymal organ tumors which uses short high voltage pulses of electricity in order to induce apoptosis of targeted cells. In this paper the application of this method of treatment in locally advanced pancreatic cancer (LAPC) and liver cancer is analyzed. MATERIAL AND METHODS: Between 04.2014 and 09.2014 two patients with LAPC and one with colorectal liver metastasis (CRLM) were qualified for treatment with irreversible electroporation...
2016: Contemporary Oncology Współczesna Onkologia
L J Savic, J Chapiro, B Hamm, B Gebauer, F Collettini
UNLABELLED: Irreversible electroporation (IRE) is the latest in the series of image-guided locoregional tumor ablation therapies. IRE is performed in a nearly non-thermal fashion that circumvents the "heat sink effect" and allows for IRE application in proximity to critical structures such as bile ducts or neurovascular bundles, where other techniques are unsuitable. IRE appears generally feasible and initial reported results for tumor ablation in the liver, pancreas and prostate are promising...
August 2016: RöFo: Fortschritte Auf Dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
P Záruba, D Hoskovec, J Lacman, J Hořejš, Z Krška, M Ryska
INTRODUCTION: Irreversible electroporation (IRE) is a quite novel method of tissue ablation. Its mechanism of action that does not use thermal energy is the most important feature of the method. Current experience with IRE in animal studies and in clinical practice are summarized in the paper. In particular, the paper is focused on using IRE in locally advanced pancreatic carcinoma. METHOD: The basic principle of IRE is that it causes micropores in the phospholipid membrane of cells...
December 2015: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Shivank S Bhatia, Rahul Arya, Govindarajan Narayanan
Irreversible electroporation (IRE) induces cell death by exposing it to high-voltage, low-energy DC current pulses. The mechanism of cell death and healing is a departure from the other existing technologies such as radiofrequency ablation, microwave ablation, and cryoablation. These thermal ablative technologies have several applications in oncology but have limitations that have also been established. IRE has shown promise to overcome some of these limitations and has enabled the use of an ablative technology in treating lesions close to the bile ducts and vasculature and in organs such as the pancreas...
September 2015: Techniques in Vascular and Interventional Radiology
Shamar J Young
Pancreatic adenocarcinoma continues to have a poor prognosis with 1 and 5 years survival rates of 27% and 6% respectively. The gold standard of treatment is resection, however, only approximately 10% of patients present with resectable disease. Approximately 40% of patients present with disease that is too locally advanced to resect. There is great interest in improving outcomes in this patient population and ablation techniques have been investigated as a potential solution. Unfortunately early investigations into thermal ablation techniques, particularly radiofrequency ablation, resulted in unacceptably high morbidity rates...
August 27, 2015: World Journal of Gastrointestinal Surgery
Robert Cg Martin, Eric Schwartz, JoAnn Adams, Ian Farah, Brian M Derhake
BACKGROUND: Irreversible electroporation (IRE) is a relatively new approach to the management of multiple types of locally advanced soft tissue tumors. Unique peri-procedural anesthetic management is needed in the safe and effective delivery of this therapy. OBJECTIVES: This study analyzed IRE therapy in relation to anesthetic management for our initial cohort and then established and validated a set of best practical guidelines for general anesthesia in patients undergoing IRE for abdominal tumors...
June 2015: Anesthesiology and Pain Medicine
Francisco Javier Trueba-Arguiñarena, Diego Soto de Prado-Otero, Rodrigo Poves-Alvarez
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...
July 2015: Medicine (Baltimore)
Stefan Fritz, Christof M Sommer, Dominik Vollherbst, Miguel F Wachter, Thomas Longerich, Milena Sachsenmeier, Jürgen Knapp, Boris A Radeleff, Jens Werner
OBJECTIVES: Use of thermal tumor ablation in the pancreatic parenchyma is limited because of the risk of pancreatitis, pancreatic fistula, or hemorrhage. This study aimed to evaluate the feasibility and safety of irreversible electroporation (IRE) in a porcine model. METHODS: Ten pigs were divided into 2 study groups. In the first group, animals received IRE of the pancreatic tail and were killed after 60 minutes. In the second group, animals received IRE at the head of the pancreas and were followed up for 7 days...
July 2015: Pancreas
Shinichi Hosokawa, Kenichiro Furuyama, Masashi Horiguchi, Yoshiki Aoyama, Kunihiko Tsuboi, Morito Sakikubo, Toshihiko Goto, Koji Hirata, Wataru Tanabe, Yasuhiro Nakano, Haruhiko Akiyama, Ryoichiro Kageyama, Shinji Uemoto, Yoshiya Kawaguchi
In the adult pancreas, there has been a long-standing dispute as to whether stem/precursor populations that retain plasticity to differentiate into endocrine or acinar cell types exist in ducts. We previously reported that adult Sox9-expressing duct cells are sufficiently plastic to supply new acinar cells in Sox9-IRES-CreERT2 knock-in mice. In the present study, using Sox9-IRES-CreERT2 knock-in mice as a model, we aimed to analyze how plasticity is controlled in adult ducts. Adult duct cells in these mice express less Sox9 than do wild-type mice but Hes1 equally...
2015: Scientific Reports
Christopher Månsson, Anders Nilsson, Britt-Marie Karlson
Irreversible electroporation (IRE) is an ablation technique that is being investigated as a potential treatment of pancreatic cancer. However, many of these patients have a metallic stent in the bile duct, which is recognized as a contraindication for IRE ablation. We report a case in which an IRE ablation in the region of the pancreatic head was performed on a patient with a metallic stent which led to severe complications. After the treatment, the patient suffered from several complications including perforation of the duodenum and transverse colon, and bleeding from a branch of the superior mesenteric artery which eventually lead to her death...
December 2014: Acta Radiologica Short Reports
Anna Maria Ierardi, Natalie Lucchina, Ejona Duka, Alessandro Bacuzzi, Gianlorenzo Dionigi, Gianpaolo Carrafiello
CONTEXT: There is little reported experience of irreversible electroporation (IRE) of locally advanced pancreatic tumors (LAP). In literature, few data reported complications. In particular vascular vasoconstriction miming splenic infarcts in humans has never been found. CASE REPORT: This report describes the onset of asymptomatic multiple little splenic perfusion defects after the treatment of a LAP localized in the boby-tail portion of the pancreas with the application of five percutaneous probes for IRE, in a 79 year-old man...
November 2014: JOP: Journal of the Pancreas
Govindarajan Narayanan, Shivank Bhatia, Ana Echenique, Rekha Suthar, Katuzka Barbery, Jose Yrizarry
PURPOSE: The purpose of the study was to evaluate the effect of Irreversible Electroporation (IRE) on vessel patency in close proximity to the ablation zone. MATERIALS AND METHODS: Between January 2010 and November 2013, 101 patients underwent percutaneous IRE procedures using the NanoKnife for primary and metastatic tumors in different organs. Age ranged from 24 to 83 years. A total of 129 lesions were treated. [liver (100), pancreas (18), kidney (3), pelvis (1), aorto-caval lymph nodes (2), adrenal (2), lung (1), retroperitoneal (1), surgical bed of a prior Whipple procedure (1)]...
December 2014: Cardiovascular and Interventional Radiology
K Nielsen, H J Scheffer, J M Vieveen, A A J M van Tilborg, S Meijer, C van Kuijk, M P van den Tol, M R Meijerink, R A Bouwman
BACKGROUND: Irreversible electroporation (IRE) is a novel tumour ablation technique involving repetitive application of electrical energy around a tumour. The use of pulsed electrical gradients carries a risk of cardiac arrhythmias, severe muscle contractions, and seizures. We aimed to identify IRE-related risks and the appropriate precautions for anaesthetic management. METHODS: All patients who were treated with IRE were prospectively included. Exclusion criteria were arrhythmias, congestive heart failure, active coronary artery disease, and epilepsy...
December 2014: British Journal of Anaesthesia
Robert C G Martin, Prejesh Philips, Susan Ellis, David Hayes, Sandeep Bagla
BACKGROUND: Irreversible electroporation (IRE) has recently been added as an additional therapeutic ablative option in patients with locally advanced cancers (LAC) involving vital structures. IRE delivers localized electric current by peri-tumoral discrete probes to attain irreversible changes in cell membrane leading to cell death. The aim of this study was to evaluate the long-term effects of IRE in the treatment of locally advanced tumors. METHODS: A prospective IRB approved evaluation of 107 consecutive patients from 7 institutions with tumors that had vascular invasion treated with IRE from 5/2010 to 1/2012...
2014: BMC Cancer
E M Dunki-Jacobs, P Philips, R C G Martin
BACKGROUND: Irreversible electroporation (IRE) is a new technique for tumour cell ablation that is reported to involve non-thermal-based energy using high voltage at short microsecond pulse lengths. In vivo assessment of the thermal energy generated during IRE has not been performed. Thermal injury can be predicted using a critical temperature model. The aim of this study was to assess the potential for thermal injury during IRE in an in vivo porcine model. METHODS: In vivo continuous temperature assessments of 86 different IRE procedures were performed on porcine liver, pancreas, kidney and retroperitoneal tissue...
August 2014: British Journal of Surgery
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