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Article

Usefulness of Imaging Response Assessment after Irreversible Electroporation of Localized Pancreatic Cancer—Results from a Prospective Cohort

1
Department of Gastrointestinal Surgery, Aalborg University Hospital, DK-9000 Aalborg, Denmark
2
Department of Clinical Science, Aalborg University, DK-9220 Aalborg Øst, Denmark
3
Clinical Cancer Research Center, Aalborg University Hospital, DK-9000 Aalborg, Denmark
4
Department of Nuclear Medicine and Radiology, Aalborg University Hospital, DK-9000 Aalborg, Denmark
5
Unit of Clinical Biostatistics, Aalborg University Hospital, DK-9000 Aalborg, Denmark
*
Author to whom correspondence should be addressed.
Academic Editor: Antonio Russo
Cancers 2021, 13(12), 2862; https://doi.org/10.3390/cancers13122862
Received: 25 April 2021 / Revised: 28 May 2021 / Accepted: 4 June 2021 / Published: 8 June 2021
(This article belongs to the Special Issue Combination and Innovative Therapies for Pancreatic Cancer)
Irreversible electroporation (IRE) is a novel therapy that is being studied for the treatment of nonmetastatic pancreatic cancer. The current methods for evaluating the treatment response after IRE have been adapted from the Response Evaluation Criteria in Solid Tumors (RECIST). However, it is uncertain whether these methods are appropriate, because the methods have not been validated. The aim of the current study was to evaluate the correlation between survival time and the most commonly used imaging assessment methods on FDG-PET/CT scans. We confirmed that the Response Evaluation Criteria in Solid Tumors (RECIST) are correlated with survival, when applied as intended. However, no correlation was found when the often-used lesion-level method was used. FDG-PET-derived data did not provide any benefit over conventional CT data. Several novel methods for lesion-level analysis were explored.
(1) Background: Irreversible electroporation (IRE) is a nonthermal ablation technique that is being studied in nonmetastatic pancreatic cancer (PC). Most published studies use imaging outcomes as an efficacy endpoint, but imaging interpretation can be difficult and has yet to be correlated with survival. The aim of this study was to examine the correlation of imaging endpoints with survival in a cohort of IRE-treated PC patients. (2) Methods: Several imaging endpoints were examined before and after IRE on 18F-fluorodeoxyglucose positron emission tomography (PET) with computed tomography. Separate analyses were performed at the patient and lesion levels. Mortality rate (MR) ratios for imaging endpoints after IRE were estimated. (3) Results: Forty-one patients were included. Patient-level analysis revealed that progressive disease (PD), as defined by RECIST 1.1, is correlated with a higher MR at all time intervals, but PD, as defined by EORTC PET response criteria, is only correlated with the MR in the longest interval. No correlation was found between PD, as defined by RECIST, and the MR in the lesion-level analysis. (4) Conclusions: Patient-level PD, as defined by RECIST, was correlated with poorer survival after IRE ablation, whereas no correlations were observed in the lesion-level analyses. Several promising lesion-level outcomes were identified. View Full-Text
Keywords: RECIST; progression; positron emission tomography; metabolic tumor volume; total lesion glycolysis; metastasis; systemic response; local response RECIST; progression; positron emission tomography; metabolic tumor volume; total lesion glycolysis; metastasis; systemic response; local response
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MDPI and ACS Style

Flak, R.V.; Fisker, R.V.; Bruun, N.H.; Stender, M.T.; Thorlacius-Ussing, O.; Petersen, L.J. Usefulness of Imaging Response Assessment after Irreversible Electroporation of Localized Pancreatic Cancer—Results from a Prospective Cohort. Cancers 2021, 13, 2862. https://doi.org/10.3390/cancers13122862

AMA Style

Flak RV, Fisker RV, Bruun NH, Stender MT, Thorlacius-Ussing O, Petersen LJ. Usefulness of Imaging Response Assessment after Irreversible Electroporation of Localized Pancreatic Cancer—Results from a Prospective Cohort. Cancers. 2021; 13(12):2862. https://doi.org/10.3390/cancers13122862

Chicago/Turabian Style

Flak, Rasmus V., Rune V. Fisker, Niels H. Bruun, Mogens T. Stender, Ole Thorlacius-Ussing, and Lars J. Petersen 2021. "Usefulness of Imaging Response Assessment after Irreversible Electroporation of Localized Pancreatic Cancer—Results from a Prospective Cohort" Cancers 13, no. 12: 2862. https://doi.org/10.3390/cancers13122862

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