Irreversible electroporation (IRE) is a non-thermal ablation technique for treatment of soft tissues. It is an emerging method for treatment of pancreatic cancer. The technique is allowing surgeons the opportunity to treat previously unresectable or locally-advanced pancreatic cancer.
IRE was developed by Dr. Rubinsky and colleagues at the University of California, Berkeley.[1]
The technique involves placing probes into the pancreatic tumor. Some medical centers are inserting the probes through the skin, but more often, laparotomy is the preferred approach, to directly visualize the cancer and involved structures. Using intraoperative ultrasound, the surgical team inserts several probes into the tumor. Short, high-voltage pulses are delivered to the tissue. These pulses create leaky cells (electroporation), which then induce death of cancer cells (apoptosis).
More commonly used ablation technologies, such as radio frequency ablation (RFA) and microwave ablation can not be used near large blood vessels typically involved with pancreatic tumors. IRE, however, is capable of killing tumor around these vessels without hurting the vessels at the same time.
Robert Martin, MD, and colleagues recently reported the largest experience with the IRE system for treatment of pancreatic cancer.[2] 200 patients with locally-advanced pancreatic cancer underwent IRE treatment. While 37% of patients had complications, he reports an impressive median overall survival of almost 25 months.
IRE is now widely available throughout the United States and manufactured by Angiodynamics.
References:
[1] Edd JF, Horowitz L, Davalos RV, Mir LM, Rubinsky B. In vivo results of a new focal tissue ablation technique: irreversible electroporation. IEEE Trans Biomed Eng. 2006 Jul;53(7):1409-15. PubMed PMID: 16830945.
[2] Martin RC 2nd, Kwon D, Chalikonda S, Sellers M, Kotz E, Scoggins C, McMasters KM, Watkins K. Treatment of 200 locally advanced (stage III) pancreatic adenocarcinoma patients with irreversible electroporation: safety and efficacy. Ann Surg. 2015 Sep;262(3):486-94; discussion 492-4. doi: 10.1097/SLA.0000000000001441. PubMed PMID: 26258317.