Evaluation of Resistance as a Measure of Successful Tumor Ablation During Irreversible Electroporation of the Pancreas

Dunki-Jacobs, Erik M.; Philips, Prejesh; Martin, Robert C.G.

doi:10.1016/j.jamcollsurg.2013.10.013

Cited by 102 publications

(84 citation statements)

References 35 publications

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“…Probe position relative to the tumor and/or vessels was evaluated in real time and was adjusted to maximize treatment effect. 21 For IRE alone (in situ), the IRE probes were placed and adjusted to bracket the entire tumor and the involved vasculature. Because of system limitations of maximal deliverable currents, typically probe exposures are 1 cm maximum, which require a series of pullbacks (∼1-3) with sequential electroporation performed.…”

Section: Methodsmentioning

confidence: 99%

“…Delivery of IRE was considered successful based on the combination of intraoperative ultrasonography and real-time assessment of resistance change of the ablation zone. 21 After completion of treatment follow-up, imaging to confirm ablation success was performed at the time 12 weeks after of IRE therapy and then at 3-month intervals. An early postoperative scanning can be performed to evaluate for early complications from this new technique such as venous thrombosis but not for treatment efficacy.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of 200 Locally Advanced (Stage III) Pancreatic Adenocarcinoma Patients With Irreversible Electroporation

et al. 2015

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Treatment of 200 Locally Advanced (Stage III) Pancreatic Adenocarcinoma Patients With Irreversible Electroporation

et al. 2015

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“…However, in contrast to thermal-based ablation techniques such as radiofrequency and microwave ablation, temperature development and exposure time to temperature are not feasible as endpoints of successful ablation with IRE [16]. Furthermore, imaging directly after the procedure is not reliable due to edema, artifactual distortion, and formation of gas pockets during IRE [17]. …”

Section: Introductionmentioning

confidence: 99%

“…Several studies have investigated methods to predict real-time treatment effectiveness [17–19]. An observed current rise during IRE of 12–15 amperes (A) has been suggested as indicator for successful ablation [17, 18].…”

Section: Introductionmentioning

confidence: 99%

Conductivity Rise During Irreversible Electroporation: True Permeabilization or Heat?

Ruarus

Vroomen

Puijk

et al. 2018

Cardiovasc Intervent Radiol

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PurposeIrreversible electroporation (IRE) induces apoptosis with high-voltage electric pulses. Although the working mechanism is non-thermal, development of secondary Joule heating occurs. This study investigated whether the observed conductivity rise during IRE is caused by increased cellular permeabilization or heat development.MethodsIRE was performed in a gelatin tissue phantom, in potato tubers, and in 30 patients with unresectable colorectal liver metastases (CRLM). Continuous versus sequential pulsing protocols (10-90 vs. 10-30-30-30) were assessed. Temperature was measured using fiber-optic probes. After temperature had returned to baseline, 100 additional pulses were delivered. The primary technique efficacy of the treated CRLM was compared to the periprocedural current rise. Seven patients received ten additional pulses after a 10-min cool-down period.ResultsTemperature and current rise was higher for the continuous pulsing protocol (medians, gel: 13.05 vs. 9.55 °C and 9 amperes (A) vs. 7A; potato: 12.70 vs. 10.53 °C and 6.0A vs. 6.5A). After cooling-down, current returned to baseline in the gel phantom and near baseline values (Δ2A with continuous- and Δ5A with sequential pulsing) in the potato tubers. The current declined after cooling-down in all seven patients with CRLM, although baseline values were not reached. There was a positive correlation between current rise and primary technique efficacy (p = 0.02); however, the previously reported current increase threshold of 12–15A was reached in 13%.ConclusionThe observed conductivity rise during IRE is caused by both cellular permeabilization and heat development. Although a correlation between current rise and efficacy exists, the current increase threshold seems unfeasible for CRLM.Electronic supplementary materialThe online version of this article (10.1007/s00270-018-1971-7) contains supplementary material, which is available to authorized users.

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“…A recent study evaluated the success of tumor ablation in locally advanced pancreatic tumor in 65 patients, but only 12 of those patients underwent percutaneous treatment as opposed to open surgical or laparoscopic treatment. Unsurprisingly, all patients who underwent percutaneous treatment developed local recurrence by 6 months, and although complications were reported, the subgroup in which they occurred was not specified [74].…”

Section: Pancreasmentioning

confidence: 99%

Advances in Interventional Oncology: Percutaneous Therapies

Muallem

Solomon

2014

Curr Radiol Rep

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The field of interventional oncology has emerged over the last decade to focus on the minimally invasive image-guided techniques for the treatment of cancer. Ablative techniques specifically have evolved in more recent years and garnered significant evidence supporting their increased inclusion in standards of care and their novel use as curative or disease-modifying therapies, while still maintaining a large role in supportive or symptomatic treatment. Percutaneous ablation will more than likely continue to evolve because of the parallel innovations in imaging and engineered medical devices used in percutaneous interventions but also the improved understanding of cancer behavior and development of personalized cancer therapy.

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Evaluation of Resistance as a Measure of Successful Tumor Ablation During Irreversible Electroporation of the Pancreas

Cited by 102 publications

References 35 publications

Treatment of 200 Locally Advanced (Stage III) Pancreatic Adenocarcinoma Patients With Irreversible Electroporation

Treatment of 200 Locally Advanced (Stage III) Pancreatic Adenocarcinoma Patients With Irreversible Electroporation

Conductivity Rise During Irreversible Electroporation: True Permeabilization or Heat?

Advances in Interventional Oncology: Percutaneous Therapies

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