Local ablation in pancreatic cancer: some answers and more questions
Mené à Amsterdam sur 68 patients atteints d'un adénocarcinome canalaire du pancréas de stade localement avancé et ayant reçu une chimiothérapie de type FOLFIRINOX (âge médian : 65 ans ; 53 % d'hommes), cet essai randomisé de phase II compare l'efficacité, du point de vue de la survie globale, et la toxicité d'une radiochirurgie guidée par IRM et d'une électroporation percutanée irréversible guidée par tomodensitométrie
There is no consensus on how to treat patients with locally advanced pancreatic cancer beyond systemic chemotherapy. A minority of patients will respond well and become candidates for surgical resection, and many will die from distant disease progression. Patients not suitable for resection but without distant spread cannot stay on systemic therapy indefinitely due to toxicity, which drives demand for locoregional options. Despite their widespread use, neither conventional radiotherapy nor higher dose stereotactic ablative body radiotherapy (SABR) has been proven to improve overall survival in locally advanced pancreatic cancer. Among several ablative modalities, irreversible electroporation has gained the most traction in locally advanced pancreatic cancer, because it has the ability to safely ablate regions containing critical structures. Irreversible electroporation is performed via both surgical and percutaneous approaches worldwide. However, irreversible electroporation has also not been proven to improve overall survival.
The Lancet Gastroenterology & Hepatology , commentaire, 2023