To solve the problem that the method based on tumor morphology or overall average parameters of tumor cannot conduct the early evaluation of tumor treatment response, we proposed a voxel-wise method. The voxel-wise method uses the method combining rigid and elastic registration algorithm to align the tumor area before and after treatment on the images which are acquired by the dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). We calculated voxel-wise volume transport constant (Ktrans) using pharmacokinetic model, and designed a threshold d to get the volume fraction of voxels which Ktrans increased significantly (F+), Ktrans decreased significantly (F-) or had no significant change (F0). Linear regression analysis was performed to get the correlation between volume fractions and pathological tumor cell necrosis rate (TCNR). We then determined the ability of volume fractions to evaluate treatment response at early stage by receiver operating characteristic (ROC) curve analysis. We performed experiments on 10 patients with soft tissue sarcomas. The results indicated that F- had significant negative correlation with TCNR (R2=0.832 8, P=0.0002), F0 has significant positively correlation with TCNR (R2=0.788 4, P=0.0006). In addition, F-(AUC=0.905,P=0.053), F0 (AUC=0.857,P=0.087) had a good ability in early tumor treatment response evaluation. Therefore, F- and F0 can be used as effective imaging biomarkers for early evaluation of tumor treatment.
ObjectiveTo investigate the working principles, recent advances, and combined therapeutic efficacy of irreversible electroporation (IRE) in pancreatic cancer treatment when integrated with conventional therapies (e.g., surgery, chemotherapy, radiotherapy, immunotherapy), and to evaluate its potential for improving patient survival outcomes and quality of life. MethodsA comprehensive analysis of recent IRE research in pancreatic cancer was performed, elucidating therapeutic mechanisms, technical merits, clinical limitations, and combinatorial effects with conventional therapies through examination of clinical trials and prospective studies. ResultsIRE induces irreversible nanopores in tumor cell membranes via high-intensity electric fields, disrupting membrane integrity and triggering apoptotic cell death. Notably, it promotes immunogenic cell death, activating dendritic cells and initiating tumor-specific immune responses. When combined with surgery, chemotherapy, radiotherapy, or immunotherapy, IRE enhances therapeutic efficacy, prolongs survival in locally advanced pancreatic cancer patients, reduces postoperative recurrence rates, and significantly improves quality of life. ConclusionsAs a non-thermal ablation technique, IRE demonstrates unique advantages in localized pancreatic cancer treatment, particularly for surgically ineligible patients, and serves as a potent adjunct to traditional therapies. With technological refinements and accumulating clinical evidence, IRE is poised to play an increasingly pivotal role in future oncology practice.