{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T19:29:06Z","timestamp":1789154946196,"version":"build-2803163510"},"reference-count":38,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,26]],"date-time":"2025-01-26T00:00:00Z","timestamp":1737849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most difficult cancers to treat, with a dismal 5-year survival rate of only 8\u201310%. This challenging prognosis highlights the urgent need for innovative therapeutic approaches to improve outcomes for patients with PDAC. Electrochemotherapy (ECT), which enhances intracellular chemotherapeutic uptake via electric pulses, has been explored for resectable, borderline resectable (BR), locally advanced (LA), recurrent, and metastatic PDAC, either as a complement to conventional treatments or as an alternative when these are not feasible or effective, offering possible benefits in symptomatic palliation and local tumor control. Methods: A systematic review was performed in accordance with PRISMA guidelines for studies assessing the efficacy of ECT in PDAC. After searching Embase, PubMed\/MEDLINE, Scopus, and Web of Science, five studies with a combined total of 43 patients in various disease stages were identified. Results: ECT showed promise in improving tumor control, alleviating cancer-related pain, and improving quality of life. One study noted a trend towards tumor size reduction of 8.3% at one-month and 16.1% at six-months follow-up (p = 0.211 and p = 0.315), although these findings were derived from studies conducted without specific comparative control groups. Severity of complication was mainly mild (Clavien\u2013Dindo I-II), while severe complications occurred in only 2.3% of patients. Median overall survival was reported in two studies as 8 months (range 2\u201319) and 11.5 months (range 1\u201374). ECT showed efficacy for symptom management, with 60% of patients reporting reduced pain\/discomfort and 40% showing enhanced quality of life in one study, while another reported pain scores as decreasing from 6 to 3 at one month and to 2 at six months. Conclusions: ECT appears to be a new promising and safe adjunct treatment modality in PDAC management across different disease stages, with potential benefits in tumor control, cancer-related pain reduction, and quality of life. Further studies are warranted to validate these findings and identify patients who could benefit most.<\/jats:p>","DOI":"10.3390\/cancers17030408","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T07:46:29Z","timestamp":1737963989000},"page":"408","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A Systematic Review of Indications and Clinical Outcomes of Electrochemotherapy in Pancreatic Ductal Adenocarcinoma"],"prefix":"10.3390","volume":"17","author":[{"given":"Gianluca","family":"Rompianesi","sequence":"first","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB S and Gery, Transplantation Service, Federico II University Hospital, Via Sergio Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4369-225X","authenticated-orcid":false,"given":"Giuseppe","family":"Loiaco","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB S and Gery, Transplantation Service, Federico II University Hospital, Via Sergio Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Rescigno","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB S and Gery, Transplantation Service, Federico II University Hospital, Via Sergio Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Benassai","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB S and Gery, Transplantation Service, Federico II University Hospital, Via Sergio Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariano Cesare","family":"Giglio","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB S and Gery, Transplantation Service, Federico II University Hospital, Via Sergio Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Campanile","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB S and Gery, Transplantation Service, Federico II University Hospital, Via Sergio Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello","family":"Caggiano","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB S and Gery, Transplantation Service, Federico II University Hospital, Via Sergio Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3915-3851","authenticated-orcid":false,"given":"Roberto","family":"Montalti","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB S and Gery, Transplantation Service, Federico II University Hospital, Via Sergio Pansini 5, 80131 Naples, Italy"},{"name":"Department of Public Health, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto Ivan","family":"Troisi","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB S and Gery, Transplantation Service, Federico II University Hospital, Via Sergio Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21590","article-title":"Cancer Statistics, 2020","volume":"70","author":"Siegel","year":"2020","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1016\/S0140-6736(20)30974-0","article-title":"Pancreatic Cancer","volume":"395","author":"Mizrahi","year":"2020","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1038\/s41575-023-00856-2","article-title":"Preoperative Chemotherapy, Radiotherapy and Surgical Decision-Making in Patients with Borderline Resectable and Locally Advanced Pancreatic Cancer","volume":"21","author":"Stoop","year":"2024","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1038\/s41575-018-0005-x","article-title":"Therapeutic Developments in Pancreatic Cancer: Current and Future Perspectives","volume":"15","author":"Neoptolemos","year":"2018","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/j.annonc.2023.08.009","article-title":"Pancreatic Cancer: ESMO Clinical Practice Guideline for Diagnosis, Treatment and Follow-Up","volume":"34","author":"Conroy","year":"2023","journal-title":"Ann. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Schepis, T., De Lucia, S.S., Pellegrino, A., del Gaudio, A., Maresca, R., Coppola, G., Chiappetta, M.F., Gasbarrini, A., Franceschi, F., and Candelli, M. (2023). State-of-the-Art and Upcoming Innovations in Pancreatic Cancer Care: A Step Forward to Precision Medicine. Cancers, 15.","DOI":"10.3390\/cancers15133423"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bonferoni, M.C., Rassu, G., Gavini, E., Sorrenti, M., Catenacci, L., Torre, M.L., Perteghella, S., Ansaloni, L., Maestri, M., and Giunchedi, P. (2021). Electrochemotherapy of Deep-Seated Tumors: State of Art and Perspectives as Possible \u201cEPR Effect Enhancer\u201d to Improve Cancer Nanomedicine Efficacy. Cancers, 13.","DOI":"10.3390\/cancers13174437"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/S0169-409X(98)00066-0","article-title":"Mechanisms of Electrochemotherapy","volume":"35","author":"Mir","year":"1999","journal-title":"Adv. Drug Deliv. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Granata, V., Fusco, R., D\u2019Alessio, V., Simonetti, I., Grassi, F., Silvestro, L., Palaia, R., Belli, A., Patrone, R., and Piccirillo, M. (2023). Percutanous Electrochemotherapy (ECT) in Primary and Secondary Liver Malignancies: A Systematic Review. Diagnostics, 13.","DOI":"10.3390\/diagnostics13020209"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Rai, Z.L., Feakins, R., Pallett, L.J., Manas, D., and Davidson, B.R. (2021). Irreversible Electroporation (IRE) in Locally Advanced Pancreatic Cancer: A Review of Current Clinical Outcomes, Mechanism of Action and Opportunities for Synergistic Therapy. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081609"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.diii.2022.09.009","article-title":"Irreversible Electroporation and Electrochemotherapy in Oncology: State of the Art","volume":"103","author":"Tasu","year":"2022","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1177\/1721727X1401200308","article-title":"Feasibility and Safety of Intraoperative Electrochemotherapy in Locally Advanced Pancreatic Tumor: A Preliminary Experience","volume":"12","author":"Granata","year":"2014","journal-title":"Eur. J. Inflamm."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ejcsup.2006.08.002","article-title":"Electrochemotherapy\u2014An Easy, Highly Effective and Safe Treatment of Cutaneous and Subcutaneous Metastases: Results of ESOPE (European Standard Operating Procedures of Electrochemotherapy) Study","volume":"4","author":"Marty","year":"2006","journal-title":"Eur. J. Cancer Suppl."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4767","DOI":"10.3748\/wjg.v23.i26.4767","article-title":"Early Radiological Assessment of Locally Advanced Pancreatic Cancer Treated with Electrochemotherapy","volume":"23","author":"Granata","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_16","unstructured":"Loiaco, G. (2024, November 16). A Systematic Review of Indications and Clinical Outcomes of Electrochemotherapy in Pancreatic Duct Adenocarcinoma. PROSPERO 2024 CRD42024594419. Available online: https:\/\/www.Crd.York.Ac.Uk\/Prospero\/Display_record.Php?ID=CRD42024594419."},{"key":"ref_17","unstructured":"Wells, G.A., Shea, B., O\u2019Connell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2024, November 03). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada; 2000. Available online: http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1046\/j.1445-2197.2003.02748.x","article-title":"Methodological Index for Non-randomized Studies (MINORS): Development and Validation of a New Instrument","volume":"73","author":"Slim","year":"2003","journal-title":"ANZ J. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41073-019-0064-8","article-title":"SANRA\u2014A Scale for the Quality Assessment of Narrative Review Articles","volume":"4","author":"Baethge","year":"2019","journal-title":"Res. Integr. Peer Rev."},{"key":"ref_20","first-page":"265","article-title":"Electrochemotherapy in Cancer Patients: First Clinical Trial in Greece","volume":"25","author":"Skarlatos","year":"2011","journal-title":"In Vivo"},{"key":"ref_21","first-page":"S44","article-title":"Electrochemotherapy (ECT) Use in Deep Seated Tumors","volume":"45","author":"Jocius","year":"2022","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"15","DOI":"10.2478\/raon-2019-0004","article-title":"Diffusion Kurtosis Imaging and Conventional Diffusion Weighted Imaging to Assess Electrochemotherapy Response in Locally Advanced Pancreatic Cancer","volume":"53","author":"Granata","year":"2019","journal-title":"Radiol. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Izzo, F., Granata, V., Fusco, R., D\u2019Alessio, V., Petrillo, A., Lastoria, S., Piccirillo, M., Albino, V., Belli, A., and Tafuto, S. (2021). Clinical Phase I\/II Study: Local Disease Control and Survival in Locally Advanced Pancreatic Cancer Treated with Electrochemotherapy. J. Clin. Med., 10.","DOI":"10.3390\/jcm10061305"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Cebron, Z., Djokic, M., Petric, M., Cemazar, M., Bosnjak, M., Sersa, G., and Trotovsek, B. (2024). Intraoperative Electrochemotherapy of the Posterior Resection Surface after Pancreaticoduodenectomy: Preliminary Results of a Hybrid Approach Treatment of Pancreatic Cancer. Bioelectrochemistry, 155.","DOI":"10.1016\/j.bioelechem.2023.108576"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"101634","DOI":"10.1016\/j.suronc.2021.101634","article-title":"New Therapeutic Strategy: Personalization of Pancreatic Cancer Treatment-Irreversible Electroporation (IRE), Electrochemotherapy (ECT) and Calcium Electroporation (CaEP)\u2014A Pilot Preclinical Study","volume":"38","author":"Kielan","year":"2021","journal-title":"Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1007\/s13304-020-00782-x","article-title":"Intraoperative Electrochemotherapy in Locally Advanced Pancreatic Cancer: Indications, Techniques and Results\u2014A Single-Center Experience","volume":"72","author":"Casadei","year":"2020","journal-title":"Updates Surg."},{"key":"ref_27","first-page":"112","article-title":"Abdominal Wall Metastasis from Pancreatic Carcinoma Treated with Electrochemotherapy (ECT): Report of Two Cases","volume":"13","author":"Giardino","year":"2011","journal-title":"HPB"},{"key":"ref_28","unstructured":"(2024, November 13). National Comprehensive Cancer Network NCCN Guidelines for Pancreatic Adenocarcinoma. Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/pancreatic.pdf."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.ejcsup.2006.08.003","article-title":"Standard Operating Procedures of the Electrochemotherapy: Instructions for the Use of Bleomycin or Cisplatin Administered Either Systemically or Locally and Electric Pulses Delivered by the CliniporatorTM by Means of Invasive or Non-Invasive Electrodes","volume":"4","author":"Mir","year":"2006","journal-title":"Eur. J. Cancer Suppl."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1080\/0284186X.2018.1454602","article-title":"Updated Standard Operating Procedures for Electrochemotherapy of Cutaneous Tumours and Skin Metastases","volume":"57","author":"Gehl","year":"2018","journal-title":"Acta Oncol. (Madr)"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.ejca.2008.10.026","article-title":"New Response Evaluation Criteria in Solid Tumours: Revised RECIST Guideline (Version 1.1)","volume":"45","author":"Eisenhauer","year":"2009","journal-title":"Eur. J. Cancer"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1200\/JCO.2006.07.3049","article-title":"Correlation of Computed Tomography and Positron Emission Tomography in Patients with Metastatic Gastrointestinal Stromal Tumor Treated at a Single Institution with Imatinib Mesylate: Proposal of New Computed Tomography Response Criteria","volume":"25","author":"Choi","year":"2007","journal-title":"J. Clin. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of Surgical Complications","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.surg.2016.11.014","article-title":"The 2016 Update of the International Study Group (ISGPS) Definition and Grading of Postoperative Pancreatic Fistula: 11 Years After","volume":"161","author":"Bassi","year":"2017","journal-title":"Surgery"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1111\/j.1526-4637.2012.01516.x","article-title":"Preliminary Validation of the Defense and Veterans Pain Rating Scale (DVPRS) in a Military Population","volume":"14","author":"Buckenmaier","year":"2013","journal-title":"Pain Med."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Szende, A., Janssen, B., and Cabases, J. (2014). Self-Reported Population Health: An International Perspective Based on EQ-5D, Springer.","DOI":"10.1007\/978-94-007-7596-1"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Izzo, F., Granata, V., Fusco, R., D\u2019Alessio, V., Petrillo, A., Lastoria, S., Piccirillo, M., Albino, V., Belli, A., and Nasti, G. (2021). A Multicenter Randomized Controlled Prospective Study to Assess Efficacy of Laparoscopic Electrochemotherapy in the Treatment of Locally Advanced Pancreatic Cancer. J. Clin. Med., 10.","DOI":"10.3390\/jcm10174011"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"765","DOI":"10.17219\/acem\/139917","article-title":"Effects of Calcium Electroporation, Electrochemotherapy, and Irreversible Electroporation on Quality of Life and Progression-Free Survival in Patients with Pancreatic Cancer: IREC Clinical Study","volume":"30","author":"Kielan","year":"2021","journal-title":"Adv. Clin. Exp. Med."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/3\/408\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:36:26Z","timestamp":1759919786000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/3\/408"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,26]]},"references-count":38,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["cancers17030408"],"URL":"https:\/\/doi.org\/10.3390\/cancers17030408","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,26]]}}}