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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   *
1   Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University, Amsterdam, The Netherlands
,
Alette H. Ruarus   *
1   Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University, Amsterdam, The Netherlands
,
Florentine E. F. Timmer
1   Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University, Amsterdam, The Netherlands
,
Bart Geboers
1   Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University, Amsterdam, The Netherlands
,
Sandeep Bagla
2   Vascular Institute of Virginia, Woodbridge, Virginia
,
Giuseppe Belfiore
3   Department of Diagnostic Imaging, S. Anna-S. Sebastiano Hospital, Caserta, Italy
,
Marc G. Besselink
4   Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
,
Edward Leen
5   Department of Experimental Medicine, Imperial College London, London, United Kingdom
,
Robert C. G. Martin II
6   Department of Surgery, University of Louisville, Louisville, Kentucky
,
Govindarjan Narayanan
7   Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Florida
,
Anders Nilsson
8   Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
,
Salvatore Paiella
9   Department of General and Pancreatic Surgery, University of Verona Hospital Trust, G. B. Rossi Hospital, Verona, Italy
,
Joshua L. Weintraub
10   Department of Radiology, Columbia University, New York, New York
,
Philipp Wiggermann
11   Department of Radiology, University Medical Center Regensburg, Germany
,
Hester J. Scheffer   #
1   Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University, Amsterdam, The Netherlands
12   Department of Radiology and Nuclear Medicine, Northwest Hospital, Alkmaar, The Netherlands
,
Martijn R. Meijerink   #
1   Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University, Amsterdam, The Netherlands
› Author Affiliations Funding This study was not supported by any funding.
G.N., R.C.G.M., H.J.S., and M.R.M. have received consulting fees and institution research support for ongoing studies from AngioDynamics, Inc.
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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

Compliance with Ethical Standards

This article does not contain any studies with human participants or animals performed by any of the authors.


For this type of study informed consent is not required.


For this type of study consent for publication is not required.


* Shared first authorship.


** Shared senior authorship.


# Note from the Editor in Chief: As per Seminars in Interventional Radiology review protocol, this paper underwent a single nonblinded peer review process.




Publication History

Article published online:
10 July 2024

© 2024. Thieme. All rights reserved.

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