First Experience of Irreversible Electroporation for Locally Advanced Pancreatic Cancer Using Clustered Electrodes

Sunday, March 30, 2025

3:00 PM – 3:09 PM CT

Location: Music City Center, 209 ABC

Presenting Author(s)

Man-Deuk Kim, MD, PhD, FSIR

Professor
Severance Hospital, Yonsei University College of Medicine, Republic of Korea

Author/Co-author(s)

JK

Joon Ho Kwon, MD

Clinical assistant professor
Severance hospital, Republic of Korea
KH

Kichang Han, MD, PhD

Associate Professor
Severance Hospital, Yonsei University, College of Medicine, Republic of Korea
JP

Juil Park, MD

Clinical Assistant Professor
Severance Hospital, Yonsei University, College of Medicine, Republic of Korea
GK

Gyoung Min Kim, MD, PhD

Assistant Professor
Yonsei University Severance Hospital, Republic of Korea
JJ

Jaesung Jo, MD

Clinical assistant professor
Severance hospital, Republic of Korea
Jong Yun Won, MD, PhD

Professor
Yonsei University College of Medicine, Severance H, Republic of Korea
HK

Hyung Cheol Kim, MD

Clinical assistant professor
Severance hospital, South Korea
MA

Mazi Turki Alosaimy, MD

Fellow
Severance Hospital, Saudi Arabia

Purpose: Precise and parallel placement of electrodes, spaced 1-2 cm apart, is essential for predictable ablation zones and to avoid high current issues in irreversible electroporation (IRE). This study aims to evaluate the feasibility and safety of IRE using newly designed clustered electrodes for the treatment of locally advanced pancreatic cancer (LAPC).

Materials and Methods: Fourteen patients (median age: 59 years, range: 48–78 years) were treated with intraoperative (n=13) or percutaneous (n=1) IRE for LAPC between September 2022 and Sep 2024. The clustered electrodes, part of the EPO system (The Standard Co., S, Korea), featured fixed distances of either 1.5 or 2 cm in double or triple configurations, with exposed tips of either 1.5 or 2 cm, were used. The IRE procedure was performed using pulse widths ranging from 70-90 μs, 90-270 pulses, and voltages between 2500-3000 V. Technical success and clinical outcomes—including complications, serum pancreatic enzyme levels, overall survival (OS), and progression-free survival (PFS)—were assessed.

Results: Tumors were located in the pancreatic head in 5 patients (35.7%) and in the body/tail in 9 patients (64.3%). The median tumor diameter in the longest axis was 2.2 cm (range: 1.3–4.0 cm). Vascular invasion was present in all patients, and bowel abutment was observed in 1 patient (7.7%). Technical success was achieved in all cases. Median baseline serum levels of amylase and lipase were 61 U/L and 24 U/L, respectively. These increased to 150 U/L (P = 0.006) and 58 U/L (P = 0.045), respectively, one day post-IRE, and normalized after one week. Two patients (16.7%) experienced small bowel bleeding following IRE, which was successfully managed with embolization. No procedure-related mortalities occurred. After a median follow-up of 27.6 months, the current median OS from diagnosis and IRE was 25 months and 13.5 months, respectively. The median PFS from diagnosis and IRE was 21.6 months and 9.9 months, respectively.

Conclusion: IRE using clustered electrodes is a feasible and safe treatment option for LAPC, demonstrating favorable survival outcomes and manageable safety profiles. The design of the clustered electrodes facilitates precise and parallel electrode placement and highlights the potential for reduced procedure time.