Consensus Guidelines of Irreversible Electroporation for Pancreatic Tumors: Protocol Standardization Using the Modified Delphi Technique

Danielle J. W. Vos; Alette H. Ruarus; Florentine E. F. Timmer; Bart Geboers; Sandeep Bagla; Giuseppe Belfiore; Marc G. Besselink; Edward Leen; Robert C. G. Martin II; Govindarjan Narayanan; Anders Nilsson; Salvatore Paiella; Joshua L. Weintraub; Philipp Wiggermann; Hester J. Scheffer; Martijn R. Meijerink

doi:10.1055/s-0044-1787164

Seminars in Interventional Radiology, Table of Contents

Semin intervent Radiol 2024; 41(02): 176-219
DOI: 10.1055/s-0044-1787164

Consensus Document

Consensus Guidelines of Irreversible Electroporation for Pancreatic Tumors: Protocol Standardization Using the Modified Delphi Technique

Danielle J. W. Vos^*

¹Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University, Amsterdam, The Netherlands

,

Alette H. Ruarus^*

¹Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University, Amsterdam, The Netherlands

,

Florentine E. F. Timmer

¹Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University, Amsterdam, The Netherlands

,

Bart Geboers

¹Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University, Amsterdam, The Netherlands

,

Sandeep Bagla

²Vascular Institute of Virginia, Woodbridge, Virginia

,

Giuseppe Belfiore

³Department of Diagnostic Imaging, S. Anna-S. Sebastiano Hospital, Caserta, Italy

,

Marc G. Besselink

⁴Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

,

Edward Leen

⁵Department of Experimental Medicine, Imperial College London, London, United Kingdom

,

Robert C. G. Martin II

⁶Department of Surgery, University of Louisville, Louisville, Kentucky

,

Govindarjan Narayanan

⁷Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Florida

,

Anders Nilsson

⁸Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden

,

Salvatore Paiella

⁹Department of General and Pancreatic Surgery, University of Verona Hospital Trust, G. B. Rossi Hospital, Verona, Italy

,

Joshua L. Weintraub

¹⁰Department of Radiology, Columbia University, New York, New York

,

Philipp Wiggermann

¹¹Department of Radiology, University Medical Center Regensburg, Germany

,

Hester J. Scheffer^#

¹Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University, Amsterdam, The Netherlands

¹²Department of Radiology and Nuclear Medicine, Northwest Hospital, Alkmaar, The Netherlands

,

Martijn R. Meijerink^#

¹Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University, Amsterdam, The Netherlands

› Author Affiliations

Abstract

Since no uniform treatment protocol for pancreatic irreversible electroporation (IRE) exists, the heterogeneity throughout literature complicates the comparison of results. To reach agreement among experts, a consensus study was performed. Eleven experts, recruited according to predefined criteria regarding previous IRE publications, participated anonymously in three rounds of questionnaires according to a modified Delphi technique. Consensus was defined as having reached ≥80% agreement. Response rates were 100, 64, and 64% in rounds 1 to 3, respectively; consensus was reached in 93%. Pancreatic IRE should be considered for stage III pancreatic cancer and inoperable recurrent disease after previous local treatment. Absolute contraindications are ventricular arrhythmias, implantable stimulation devices, congestive heart failure NYHA class 4, and severe ascites. The inter-electrode distance should be 10 to 20 mm and the exposure length should be 15 mm. After 10 test pulses, 90 treatment pulses of 1,500 V/cm should be delivered continuously, with a 90-µs pulse length. The first postprocedural contrast-enhanced computed tomography should take place 1 month post-IRE, and then every 3 months. This article provides expert recommendations regarding patient selection, procedure, and follow-up for IRE treatment in pancreatic malignancies through a modified Delphi consensus study. Future studies should define the maximum tumor diameter, response evaluation criteria, and the optimal number of preoperative FOLFIRINOX cycles.

Keywords

irreversible electroporation - pancreatic tumors - modified Delphi technique - interventional radiology

Full Text

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