Role of imaging in the applicability of irreversible electroporation for the management of pancreatic adenocarcinoma

Abstract Pancreatic ductal adenocarcinoma is one of the most aggressive malignant neoplasms, with a one-year survival rate below 20%. Axial methods (computed tomography and magnetic resonance imaging) play a fundamental role in the diagnosis and staging of the disease, because they provide adequate anatomical resolution in the assessment of key structures, mainly vascular structures. Pancreatic ductal adenocarcinoma is most often discovered in advanced stages, when surgical resection is no longer feasible. In that scenario, minimally invasive treatment alternatives have been developed in attempts to change the natural history of the disease. Irreversible electroporation, an interventional procedure that minimizes deleterious effects on adjacent tissues, has proven useful for the treatment of tumors traditionally considered unresectable. Despite the growing acknowledgment of this technique as a tool for the management of pancreatic ductal adenocarcinoma, it is still relatively unknown among radiologists. In this study, we sought to provide an overview of the main characteristics and eligibility criteria that must be considered for the indication of irreversible electroporation in cases of pancreatic ductal adenocarcinoma.

摘要：胰腺导管腺癌（Pancreatic ductal adenocarcinoma）是恶性程度最高的恶性肿瘤之一，一年生存率低于20%。轴位成像方法包括计算机断层扫描（computed tomography）与磁共振成像（magnetic resonance imaging），其可在评估关键结构（主要为血管结构）时提供充足的解剖分辨率，因此在该病的诊断与分期中发挥基础性作用。胰腺导管腺癌多在晚期被检出，此时已无法实施手术切除。针对该场景，学界已开发出多种微创治疗方案，以期改变该病的自然病程。不可逆电穿孔（irreversible electroporation）作为一种可最大限度降低对邻近组织损伤的介入操作，已被证实可用于治疗传统上被认为不可切除的肿瘤。尽管该技术作为胰腺导管腺癌管理手段的认可度日益提升，但在放射科医师中仍相对鲜为人知。本研究旨在概述胰腺导管腺癌患者接受不可逆电穿孔治疗时需考量的主要特征与入选标准。