Optimal Irreversible Electroporation Techniques in the Treatment of Locally Advanced Liver and Pancreatic Cancer

Initially diagnosed stage 3 (locally advanced) Pancreatic adenocarcinoma (LAPC) remains an aggressive tumor with an overall poor prognosis (current median survival chemotherapy and radiation therapy of 9-12 months). Improvement in survival can be achieved in the small percentage that can undergo an R0 resection or where all macroscopic tumor can be cleared by local ablation. Long duration (>4-6 months) chemoradiotherapy is not tolerated by all patients and still fails to prolong survival alone. Neoadjuvant treatment also has limited results on pain control or tumor downstaging since most current modalities do not shrink or downsize the tumor. In recent years, there has been a growing interest in the use of local ablative therapy for the treatment of nonresectable tumours in various organs. Ablation techniques are based on direct application of chemical, thermal, or electrical energy to a tumor, which leads to cellular necrosis without removal of the tumor. With ablation, local control, and relief from symptoms can be obtained in the majority of the patients when appropriate patient selection and technique is utilized. LAPC has been treated by various ablation techniques in the last few years with promising results. We present the current status of local ablative therapies in the treatment of LAPC and investigate on the efficiency and future trends.