Advances in the Ablative Management of Hepatocellular Carcinoma

Liver‐tumor mimics as a potential translational framework for planning and testing irreversible electroporation with multiple electrodes

“…In this manner, the appropriate treatment parameters may be tuned in vitro rather than in vivo, as recommended in Arena et al 10 Our investigation builds on exhibiting the assets of IRE as an effective minimally-invasive ablation procedure based on a treatment planning that emphasizes a precise ablation, aiming at preventing either reversible electroporation due to the application of a lower voltage, or thermal damage caused by a higher voltage. 1,4 4 | MATERIALS AND METHODS 3D-cell-cultures have been utilized as a powerful experimental tool for investigating tumor progression, and IRE in vitro 10,[17][18][19][28][29][30][31] since they confer appropriate polarity to cells and mimic the elements in the extracellular matrix (ECM), which influence cell differentiation, proliferation, migration, and shape. 28,31,32 Moreover, they incorporate the interaction between cells and between a cell and the ECM that in vivo tumors comprise.…”

“…4 Moreover, IRE exhibits advantages over other ablative methods for soft tissue since it is a non-ionizing non-thermal localized process, which is most suitable in neoplasia located near critical structures such as blood vessels, major bile ducts, and nerves, which must be preserved for further angiogenesis. 1,4,[6][7][8] IRE induces the permanent permeabilization of the cell membrane, provoking a necrotic process after its exposure to a sufficiently high pulsed electric field (EF). [9][10][11] IRE consists of the local delivery of high-voltage electric pulses through needle-electrodes placed in the target neoplasia.…”

“…Worldwide, liver cancer is a concerning pathology, frequently with poor prognoses due to its diagnosis in advanced stages 1,2 . Hepatocellular carcinoma (HCC) is the most persistent type, representing more than 90% of the primary liver cancers, for which systemic toxic chemotherapy with immunotherapy are mainly offered to the patients to counteract the multidrug resistance 2 .…”

“…Yet for early diagnoses, partial liver resection is suitable for only 5%–10% of patients with a small (<2 cm) nonmetastatic disease from which half of them recur within 2 years after surgery 3 . Next to liver surgery, numerous ablation therapies have come to light as curative alternatives and as a means of sustainability of hepatic tissue, for example, radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation, localized drug delivery with electrochemotherapy (ECT), and irreversible electroporation (IRE) 1,4,5 . At present, RFA is the most used ablation therapy in HCC treatment, showing a local recurrence up to 31%.…”

“…Nonetheless, IRE is being increasingly preferred since it has reduced the local recurrence to 7.5% while lacking the heat‐sink effect 4 . Moreover, IRE exhibits advantages over other ablative methods for soft tissue since it is a non‐ionizing non‐thermal localized process, which is most suitable in neoplasia located near critical structures such as blood vessels, major bile ducts, and nerves, which must be preserved for further angiogenesis 1,4,6–8 …”