High-Voltage Electrical Pulses in Oncology: Irreversible Electroporation, Electrochemotherapy, Gene Electrotransfer, Electrofusion, and Electroimmunotherapy

Geboers, Bart; Scheffer, Hester J.; Graybill, Philip M.; Ruarus, Alette H.; Nieuwenhuizen, Sanne; Puijk, Robbert S.; Tol, M. Petrousjka van den; Davalos, Rafael V.; Rubinsky, Boris; Gruijl, Tanja D. de; Miklavčič, Damijan; Meijerink, Martijn R.

doi:10.1148/radiol.2020192190

Cited by 258 publications

(173 citation statements)

References 131 publications

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“…Unfortunately, tumor location near critical structures can lead to hemorrhaging, heat sink effects, and healthy tissue damages during treatment ( 5 , 6 ). Non-thermal modalities such as those that utilize electroporation can overcome these treatment barriers to induce cell death through different mechanisms and may initiate systemic immune responses to target both the local tumor microenvironment and metastatic sites ( 7 – 10 ).…”

Section: Introductionmentioning

confidence: 99%

Starting a Fire Without Flame: The Induction of Cell Death and Inflammation in Electroporation-Based Tumor Ablation Strategies

et al. 2020

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New therapeutic strategies and paradigms are direly needed for the treatment of cancer. While the surgical removal of tumors is favored in most cancer treatment plans, resection options are often limited based on tumor localization. Over the last two decades, multiple tumor ablation strategies have emerged as promising stand-alone or combination therapeutic options for patients. These strategies are often employed to treat tumors in areas where surgical resection is not possible or where chemotherapeutics have proven ineffective. The type of cell death induced by the ablation modality is a critical aspect of therapeutic success that can impact the efficacy of the treatment and systemic anti-tumor immune system responses. Electroporation-based ablation technologies include electrochemotherapy, irreversible electroporation, and other modalities that rely on pulsed electric fields to create pores in cell membranes. These pores can either be reversible or irreversible depending on the electric field parameters and can induce cell death either alone or in combination with a therapeutic agent. However, there have been many controversial findings among these technologies as to the cell death type initiated, from apoptosis to pyroptosis. As cell death mechanisms can impact treatment side effects and efficacy, we review the main types of cell death induced by electroporation-based treatments and summarize the impact of these mechanisms on treatment response. We also discuss potential reasons behind the variability of findings such as the similarities between cell death pathways, differences between cell-types, and the variation in electric field strength across the treatment area.

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Section: Introductionmentioning

confidence: 99%

Starting a Fire Without Flame: The Induction of Cell Death and Inflammation in Electroporation-Based Tumor Ablation Strategies

et al. 2020

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“…RFA, microwave ablation (MWA) and in particular irreversible electroporation (IRE). [7][8][9] However, the main difference between electrochemotherapy and other local ablative therapies is that electrochemotherapy combines two modalities, chemotherapy and the application of electric pulses. Thus, the tumor cells are dying not directly due to the application of physical energy, such as in the case of other local thermal ablative therapies or IRE, but due to the action of chemotherapeutic drug, which in the case of bleomycin means that the cells are dying by mitotic cell death.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies demonstrate the feasibility and safety of percutaneous approach of IRE in treatment of liver tumors, including HCC. 9 , 15 , 16 , 17 Some reports describe percutaneous approach also for electrochemotherapy of cholangiocarcinoma, spine metastases 18 , 19 , lysis of portal vein thrombosis in hepatic hilum, and metastasis from renal cell cancer, however not in treatment of HCC. 20 , 21 , 22 , 23 In this report we therefore tested the feasibility, safety and effectiveness of electrochemotherapy with image guided percutaneous approach, in a patient with HCC.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous image guided electrochemotherapy of hepatocellular carcinoma: technological advancement

Djokić

Dežman

Čemažar

et al. 2020

Radiology and Oncology

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AbstractBackgroundElectrochemotherapy is an effective treatment of colorectal liver metastases and hepatocellular carcinoma (HCC) during open surgery. The minimally invasive percutaneous approach of electrochemotherapy has already been performed but not on HCC. The aim of this study was to demonstrate the feasibility, safety and effectiveness of electrochemotherapy with percutaneous approach on HCC.Patient and methodsThe patient had undergone the transarterial chemoembolization and microwave ablation of multifocal HCC in segments III, V and VI. In follow-up a new lesion was identified in segment III, and recognized by multidisciplinary team to be suitable for minimally invasive percutaneous electrochemotherapy. The treatment was performed with long needle electrodes inserted by the aid of image guidance.ResultsThe insertion of electrodes was feasible, and the treatment proved safe and effective, as demonstrated by control magnetic resonance imaging.ConclusionsMinimally invasive, image guided percutaneous electrochemotherapy is feasible, safe and effective in treatment of HCC.

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“…EP can inactivate malignant cells in situ rapidly while sparing tissue scaffolds such as the extracellular matrix, vascular wall, and nerve bre as a result. Meanwhile, EP is not affected by the heat sink effect, so the blood vessel adjacent to the ablation area will not be a contraindication [6]. These advantages of IRE prominently expanded the application of tissue ablation techniques, especially for heatsensitive structures, which are usually out-of-bound areas for tissue ablation.…”

Section: Introductionmentioning

confidence: 99%

Physiological and Histopathological Effects of Electroporation Pulse on Stomach of Rats

Zhang

Han

et al. 2020

Preprint

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BackgroundElectroporation pulse (EP) is an emerging tissue ablation technique with widespread potential, including in the treatment of multiple cancer types. However, there is a lack of knowledge about its effect on the physiology and histopathology of stomachs. The aim of this study was to investigate biological effects of EP applied to stomachs of healthy rats on digestive function, serum marker levels, and gastric tissue structure.MethodsNinety male rats were divided into nine groups and examined up to 28 days post-treatment. A single burst of electroporation pulses (500 V, 99 pluses, 1 Hz, 100 μs) was delivered to the stomachs of the rats using a forceps electrode. Gastric emptying, small intestinal transit, and gastric secretion were measured to evaluate digestive function. Levels of serum markers were determined using ELISA. Haematoxylin–eosin, Masson trichrome, and immunofluorescence were performed for histopathological analysis.ResultsNo significant effect on gastric emptying or secretion were found post-EP, whereas the small intestinal transit decreased at 4 h and rapidly recovered to normal on 1-day post-EP. Further, levels of serum markers such as TNF-α and IL-1β changed temporarily in the acute term but soon returned to normal within 28 days. Moreover, histopathological analysis revealed that that the cell death in ablation area occurred immediately post-EP, and the gastric wall scaffold in the ablation region remained intact post-EP.ConclusionsThis study demonstrates the safety and efficacy of EP on the physiology and histopathology of the stomach and lays a foundation for the wider use of this technique in future studies.

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High-Voltage Electrical Pulses in Oncology: Irreversible Electroporation, Electrochemotherapy, Gene Electrotransfer, Electrofusion, and Electroimmunotherapy

Cited by 258 publications

References 131 publications

Starting a Fire Without Flame: The Induction of Cell Death and Inflammation in Electroporation-Based Tumor Ablation Strategies

Starting a Fire Without Flame: The Induction of Cell Death and Inflammation in Electroporation-Based Tumor Ablation Strategies

Percutaneous image guided electrochemotherapy of hepatocellular carcinoma: technological advancement

Physiological and Histopathological Effects of Electroporation Pulse on Stomach of Rats

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