IMage-guided Pancreatic Ablation for Cancer Therapy (IMPACT) (360G-Wellcome-201080_Z_16_Z)

In the UK, 8,773 people were diagnosed with pancreatic cancer in 2011 and there were 8,662 deaths from pancreatic cancer in 20125. Pancreatic cancer is a biologically aggressive cancer, which is resistant to chemotherapy and radiotherapy and has a high rate of recurrence6-8. Surgical resection remains the only treatment with potential for long-term survival and cure. However, many patients have metastatic disease at presentation and a third have locally advanced pancreatic cancer, leaving only 10% - 20% suitable for potentially curative resection9. Even after resection, recurrence is common leading to an overall five-year survival ranging from 7% - 25%8, 10-14, with a median survival of 11-15 months15. Adjuvant chemotherapy is beneficial but still only delivers a median survival of between 14 to 24 months16. In people who do not undergo resection, the median survival is only about 8-9 months17. Thermal ablation, which is established for palliation of other cancers18, is not recommended for unresectable pancreatic cancer because of risk of injury to the pancreatic duct resulting in acute pancreatitis and fistulae and the proximity to major blood vessels including the portal vein and aorta which may be damaged and which also drain heat making the procedure ineffective19. This project will develop a patient-specific planning, simulation and intra- operative navigation system for individualised ablation and palliation of inoperable pancreatic cancer. We will investigate a new technique – irreversible electroporation ablation (IRE) – which causes cell death through a different mechanism to thermal ablation that can minimise damage to the pancreatic duct and major blood vessels. To be effective IRE, however, needle electrodes must be accurately positioned within the pancreas. There is currently no way of placing the IRE electrodes to achieve this accurate placement of electrodes. The proposed navigation system will address this problem so that electrode placement can be carried out percutaneously or under laparoscopic guidance. We will develop the navigation system, test it in animal experiments and prepare a first-in-man trial. The potential impact of the project will be to prolong and increase the quality of life for a patient population with dismal prognosis and limited treatment options.