Electrochemotherapy as treatment option for hepatocellular carcinoma, a prospective pilot study

Djokić, Mihajlo; Čemažar, Maja; Popovič, Peter; Kos, Bor; Dežman, Rok; Bošnjak, Maša; Žakelj, Martina Nikšić; Miklavčič, Damijan; Potrč, Stojan; Štabuc, Borut; Tomažič, Aleš; Serša, Gregor; Trotovšek, Blaž

doi:10.1016/j.ejso.2018.01.090

Cited by 76 publications

(83 citation statements)

References 51 publications

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“… 26 These first results show the potential of percutaneous ECT in case of Vp3-Vp4 PVTT treatment. A recently published study 94 tested, in a prospective pilot study on HCC, the effectiveness of ECT. They obtained a complete response rate of 88% per treated lesion (lesion size: 8-41 mm) and confirmed feasibility and safety, as no treatment or postoperative adverse events were recorded, even in cases with lesions located near the major hepatic vessels.…”

Section: Electrochemotherapy In Clinical Practicementioning

confidence: 99%

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Electrochemotherapy as a New Modality in Interventional Oncology: A Review

Probst

Fuhrmann

Beyer

et al. 2018

Technol Cancer Res Treat

136

111

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Electroporation is a well-known phenomenon that occurs at the cell membrane when cells are exposed to high-intensity electric pulses. Depending on electric pulse amplitude and number of pulses, applied electroporation can be reversible with membrane permeability recovery or irreversible. Reversible electroporation is used to introduce drugs or genetic material into the cell without affecting cell viability. Electrochemotherapy refers to a combined treatment: electroporation and drug injection to enhance its cytotoxic effect up to 1000-fold for bleomycin. Since several years, electrochemotherapy is gaining popularity as minimally invasive oncologic treatment. The adoption of electrochemotherapy procedure in interventional oncology poses several unsolved questions, since suitable tumor histology and size as well as therapeutic efficacy still needs to be deepen. Electrochemotherapy is usually applied in palliative settings for the treatment of patients with unresectable tumors to relieve pain and ameliorate quality of life. In most cases, it is used in the treatment of advanced stages of neoplasia when radical surgical treatment is not possible (eg, due to lesion location, size, and/or number). Further, electrochemotherapy allows treating tumor nodules in the proximity of important structures like vessels and nerves as the treatment does not involve tissue heating. Overall, the safety profile of electrochemotherapy is favorable. Most of the observed adverse events are local and transient, moderate local pain, erythema, edema, and muscle contractions during electroporation. The aim of this article is to review the recent published clinical experiences of electrochemotherapy use in deep-seated tumors with particular focus on liver cases. The principle of electrochemotherapy as well as the application to cutaneous metastases is briefly described. A short insight in the treatment of bone metastases, unresectable pancreas cancer, and soft tissue sarcoma will be given. Preclinical and clinical studies on treatment efficacy with electrochemotherapy of hepatic lesions and safety of the procedure adopted are discussed.

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Section: Electrochemotherapy In Clinical Practicementioning

confidence: 99%

“…Djokic et al 94 reported the results of a prospective study conducted in patients with HCC. Electrochemotherapy with BLM was performed on 17 HCCs in 10 patients.…”

Section: Electrochemotherapy In Clinical Practicementioning

confidence: 99%

Electrochemotherapy as a New Modality in Interventional Oncology: A Review

Probst

Fuhrmann

Beyer

et al. 2018

Technol Cancer Res Treat

136

111

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“… 11 Recently similar results were obtained in phase I studi after ECT of hepatocellular carcinoma tumors. 12 …”

Section: Introductionmentioning

confidence: 99%

Ultrasonographic changes in the liver tumors as indicators of adequate tumor coverage with electric field for effective electrochemotherapy

Boc

Edhemović

Kos

et al. 2018

Radiology and Oncology

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BackgroundThe aim of the study was to characterize ultrasonographic (US) findings during and after electrochem-otherapy of liver tumors to determine the actual ablation zone and to verify the coverage of the treated tumor with a sufficiently strong electric field for effective electrochemotherapy.Patients and methodsUS findings from two representative patients that describe immediate and delayed tumor changes after electrochemotherapy of colorectal liver metastases are presented.ResultsThe US findings were interrelated with magnetic resonance imaging (MRI). Electrochemotherapy-treated tumors were exposed to electric pulses based on computational treatment planning. The US findings indicate immediate appearance of hyperechogenic microbubbles along the electrode tracks. Within minutes, the tumors became evenly hyperechogenic, and simultaneously, an oedematous rim was formed presenting as a hypoechogenic formation which persisted for several hours after treatment. The US findings overlapped with computed electric field distribution in the treated tissue, indicating adequate coverage of tumors with sufficiently strong electric field, which may predict an effective treatment outcome.ConclusionsUS provides a tool for assessment of appropriate electrode insertion for intraoperative electrochemo-therapy of liver tumors and assessment of the appropriate coverage of a tumor with a sufficiently strong electric field and can serve as predictor of the response of tumors.

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“…The use of EP is possible and effective in any tissues; just consider that it is currently used mainly to the skin and to the subcutaneous tissue, where it has filled a "therapeutic vacuum" [10,11]. The efficacy of ECT and IRE has already been demonstrated in metastasis of non-superficial tumors, such as liver cancer [13][14][15][16][17][18][19], rectal cancer [20][21][22], primitive pancreatic cancer [23][24][25][26][27][28], esophageal tumors [28], and bone metastasis [29].…”

Section: Introductionmentioning

confidence: 99%

New Deployable Expandable Electrodes in the Electroporation Treatment in a Pig Model: A Feasibility and Usability Preliminary Study

Izzo

Ionna

Granata

et al. 2020

Cancers

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The aim of the study is to evaluate the usability aspects of new deployable, expandable, electrode prototypes, in terms of suitability solutions for laparoscopic applications on the liver, endoscopic trans-oral and trans-anal procedures, electroporation segmentation in several steps, mechanical functionality (flexibility, penetrability), visibility of the electrode under instrumental guidance, compatibility of the electrode with laparoscopic/endoscopic accesses, surgical instruments, and procedural room and safety compatibility. The electroporation was performed on an animal model (Sus Scrofa Large White 60 kg) both in laparoscopy and endoscopy, under ultrasound guidance, and in open surgery. Electrodes without divergence, with needles coming out straight, parallel to each other, and electrodes with peripheral needles (four needles), diverging from the electrode shaft axis (electrode with non-zero divergence) have been tested. To cause an evaluable necrosis effect, the number of electrical pulses was increased to induce immediate liver cell death. Histological samples were analyzed by staining with Haematoxylin/Eosin or by immunohistochemical staining to confirm complete necrosis. The prototypes of expandable electrodes, tested in laparoscopy and endoscopy and in open surgery, respectively, are suitable in terms of usability, electroporation segmentation in several steps, mechanical functionality (flexibility, penetrability), visibility under instrumental guidance, compatibility with laparoscopic/endoscopic accesses, surgical instruments and procedural room safety, patient safety (no bleeding and/or perforation), and treatment efficacy (adequate ablated volume). Electroporation treatment using new deployable expandable electrode prototypes is safe and feasible. Moreover, electrode configurations allow for a gradual increase in the ablated area in consecutive steps, as confirmed by histology and immunohistochemistry.

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Electrochemotherapy as treatment option for hepatocellular carcinoma, a prospective pilot study

Cited by 76 publications

References 51 publications

Electrochemotherapy as a New Modality in Interventional Oncology: A Review

Electrochemotherapy as a New Modality in Interventional Oncology: A Review

Ultrasonographic changes in the liver tumors as indicators of adequate tumor coverage with electric field for effective electrochemotherapy

New Deployable Expandable Electrodes in the Electroporation Treatment in a Pig Model: A Feasibility and Usability Preliminary Study

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