Minimally invasive image-guided therapy of primary and metastatic pancreatic cancer

Table 1 Studies evaluating intraoperative pancreas radiofrequency ablation

Ref.	Study type	Patients	Outcome measure	Results	Complica-tions
Giardino et al[16], 2013	Retrospective	107	OS	RFA 1st line: 14.7 mo RFA + adjuvant: 25.6 mo	Mortality: 1.8%; morbidity: 28%
Girelli et al[18], 2013	Prospective	100	OS and DSS	20 and 23 mo	Mortality 3%; morbidity 24%
Girelli et al[14], 2010	Prospective	50	Safety and feasibility	-	Mortality 2%; morbidity 24%
Spiliotis et al[15], 2007	Retrospective	25	OS	OS: 33 mo1	Mortality: 0%; morbidity: 23%
Wu et al[13], 2006	Prospective	16	Pain relief	50% pain relief	90-d mortality: 25%;
Matsui et al[12], 2000	Prospective	29	OS	OS: 3 mo	Mortality: 10%

¹Mean value. OS: Overall survival; DFS: Disease-free survival; PFS: Progression-free survival; DSS: Disease-specific survival.

Table 2 Studies evaluating microwave ablation of pancreatic cancer

Ref.	Patients	Survival	Procedure	Guidance	Major adverse events
Lygidakis et al[23], 2007	15	Up to 22 mo	Open	N/A	No
Carrafiello et al[21], 2013	10	80% at 1 yr	5 open, 5 percutaneous	US, US/CT	2
Vogl et al[24], 2018	20	N/A	Percutaneous	CT	No
Ierardi et al[22], 2018	5	N/A	Percutaneous	US	No

US: Ultrasound; CT: Computed tomography.

Table 3 Studies evaluating intraoperative irreversible electroporation of pancreatic cancer

Author	Patients	Median OS(mo)	Guidancemodality	Major adverse events
Paiella et al[53], 2015	10	7.5	US	20%
Martin et al[48], 2015	200	24.9	US	22%
Kluger et al[52], 2015	50	7.7	Not reported	38%
Lambert et al[54], 2015	21	10.2	Not reported	24%
Yan et al[57], 2016	25	Not reported	US	16%
Vogel et al[50], 2017	15	16	US	53%
Huang et al[47], 2018	70	22.6	US	4%
Yang et al[105], 2020	74	53% (3 yr)1	US	12%
He et al[106], 2020	36	53.5% (2 yr)2	US	5%
He et al[49], 2020	167	16	US	N/A

¹Survival probability at 3-year.

²Survival probability at 2-year. US: Ultrasound.

Table 4 Studies evaluating percutaneous IRE in pancreatic cancer

Ref.	Patients	Median OS from IRE	Guidance	Major adverse events
Belfiore et al[64], 2015	20	13.951 mo	CT	0%
Narayanan et al[61], 2017	50	14.2 mo	CT	20%
Zhang et al[58], 2017	21	N/A	CT/US	0%
Scheffer et al[65], 2017	25	11 mo	CT	40%
Månsson et al[59], 2019	24	13.3 mo	US	25%
Flak et al[60], 2019	33	10.7 mo	US	20%
Ruarus et al[62], 2020	50	10 mo	CT	42%
Ma et al[51], 2020	33	19.8 mo	CT	9%

¹Mean value. CT: Computed tomography; US: Ultrasound.

Table 5 Active pancreas irreversible electroporation clinical trials (source: ClinicalTrials.gov)

Title	Location	Hyperlink	Patients	Estimated completion
An open-label, multicenter, prospective study of IRE (Nano Knife) combined with radiotherapy and chemotherapy in patients with LAPC	Shanghai, China	https://clinicaltrials.gov/ct2/show/NCT04310553	40	December, 2020
Ablation of unresectable LAPC with IRE system	Teaneck, New Jersey, United States	https://clinicaltrials.gov/ct2/show/NCT03614910	30	May, 2023
Chemotherapy followed by irreversible electroporation in patients with unresectable LAPC	Aalborg, Denmark	https://clinicaltrials.gov/ct2/show/NCT04093141	30	May, 2024
Chemotherapy and IRE in the treatment of advanced pancreatic adenocarcinoma	Louisville, Kentucky, United States	https://clinicaltrials.gov/ct2/show/NCT03484299	20	December, 2023
PANFIRE-3 trial: Assessing safety and efficacy of IRE + Nivolumab + CpG for metastatic pancreatic cancer	Amsterdam, North-Holland, Netherlands	https://clinicaltrials.gov/ct2/show/NCT04612530	18	October, 2022
Outcomes of ablation of unresectable pancreatic cancer using the nanoknife IRE system	Baltimore, Maryland, United States	https://clinicaltrials.gov/ct2/show/NCT02041936	12	December, 2021
Immunotherapy and IRE in the treatment of advanced pancreatic adenocarcinoma	Louisville, Kentucky, United States	https://clinicaltrials.gov/ct2/show/NCT03080974	10	April, 2022
A study of the use of IRE in pancreatic ductal cancer	Toronto, Ontario, Canada	https://clinicaltrials.gov/ct2/show/NCT03257150	47	September, 2021
Safety and efficacy of IRE for LAPC	Seoul, Korea, Republic of	https://clinicaltrials.gov/ct2/show/NCT02898649	100	August, 2019
IRE (Nano Knife) for the treatment of pancreatic adenocarcinoma	Poitiers, France	https://clinicaltrials.gov/ct2/show/NCT03105921	20	June, 2020
IRE for inoperable hepatic and pancreatic malignancy	Hong Kong	https://clinicaltrials.gov/ct2/show/NCT02822716	35	December, 2021
Phase II/III of randomized controlled clinical research on IRE synchronous chemotherapy for LAPC	Guangzhou, Guangdong, China	https://clinicaltrials.gov/ct2/show/NCT03673137	120	November, 2021
Anti-tumor immunity induced by IRE of unresectable pancreatic cancer	Guangzhou, Guangdong, China	https://clinicaltrials.gov/ct2/show/NCT02343835	20	January, 2025
A pivotal study of safety and effectiveness of Nano Knife IRE for stage 3 pancreatic cancer	USA, Multicentre	https://clinicaltrials.gov/ct2/show/NCT03899636	528	December, 2023
Immunologic signatures following surgery for pancreatic cancer	Durham, North Carolina, United States	https://clinicaltrials.gov/ct2/show/NCT03001518	30	April, 2027

IRE: Irreversible electroporation; LAPC: Locally advanced pancreatic cancer.

Table 6 Studies evaluating percutaneous liver ablation in metastatic pancreatic cancer

Ref.	Modality	Patients	Median OS from ablation	Guidance	Major adverse events
Park et al[77], 2012	RFA	34	14 mo	US	Not reported
Hua et al[78], 2017	RFA	102	11.4 mo	US	9.8%
Lee et al[79], 2020	RFA	94	12 mo	US (n = 91), CT (n = 3)	8.5%
Bailey et al[80], 2019	Mixed	20	9.7 mo	Mixed	N/A

US: Ultrasound; CT: Computed tomography.

Table 7 Transarterial chemoembolization in liver-metastatic pancreatic cancer

Ref.	Patients	Median OS from TACE	Technique
Vogl et al[82], 2015	112	19.2 mo	cTACE after mitomycin C, cisplatin, and gemcitabine chemoperfusion
Azizi et al[83], 2011	32	16 mo	cTACE after mitomycin C, cisplatin, and gemcitabine chemoperfusion
Sun et al[84], 2017	27	23 mo	Chemoperfusion with gemcitabine, oxaplatin, and irinotecan plus embolization with Lipiodol + pirarubicin or DEB with pirarubicin

OS: Overall survival; TACE: Transarterial chemoembolization; cTACE: Conventional transarterial chemoembolization.

Table 8 Transarterial radioembolization in liver-metastatic pancreatic cancer

Ref.	Patients	Median OS from TARE	Technique
Michl et al[96], 2014	19	9 mo	Resin microspheres
Kim et al [97], 20161	16	12.5 mo	Resin microspheres
Kim et al[99], 20171	24	6 mo	Resin microspheres
Kim et al[98], 20191	33	8.1 mo	Resin microspheres
Kayaleh et al[100], 2020	26	7 mo	Glass microspheres

¹Patient cohort in studies by Kim et al may overleap. OS: Overall survival; TACE: Transarterial chemoembolization.