Irreversible Electroporation for Unresectable Hepatocellular Carcinoma: Initial Experience and Review of Safety and Outcomes

Abstract

The aims of this study were to evaluate the safety, feasibility and tumour response of irreversible electroporation, a non-thermal ablation technique, for the treatment of unresectable hepatocellular carcinoma. The endpoints were safety and local treatment efficacy.Patients with unresectable tumours and tumours not amenable for radiofrequency ablation because of their vicinity to organs vulnerable to thermal damage such as the bowel or because they were close to large blood vessels that would limit efficacy of ablation due to the heat sink effect were treated with irreversible electroporation using percutaneous ultrasound and/or computed tomography guided electrode placement between November 2008 and December 2009. Early, late, minor and major complications were recorded. Tumour response was determined on triphasic helical computed tomography follow-up at one month, then every three months post-procedure. Eleven patients received IRE therapy to 18 HCC lesions (Mean diameter 2.44 6 0.99 cm; range 1.0-6.1 cm) with five patients having more than one treated HCC. Mean follow-up was 18 months (range 14-24 months). Six patients required repeat treatments for local residual or recurrent disease; two of these also had IRE for distant intrahepatic recurrence. No serious complications were observed despite seven lesions lying adjacent to important structures or organs. Four patients developed transient urinary retention and seven developed transient local post-procedure pain. After IRE therapy, 13 (72%) lesions were completely ablated with 93% success for lesions 3 cm (13/14). The local recurrence-free period was 18 6 4 months and the distance recurrence free period was 14 6 6 months. These preliminary results suggest that IRE is a safe and feasible technique for local ablation of HCC, particularly for lesions less than 3 cm. No major complications were encountered during this study even for tumours close to essential structures or organs.

Irreversible Electroporation in Interventional Oncology: Where We Stand and Where We Go

“…Except for transient postprocedural pain (64 %), no complications were observed in this study. At 6 mo, response evaluation revealed CR in a total of 72 % and 93 % of tumors ≤ 3 cm and the local progression-free survival (PFS) was 18 ± 4 mo and the distance PFS was 14 ± 6 mo [24]. The previous findings are also in line with the preliminary results of a prospective multicenter phase II trial conducted by Lencioni et al using IRE for the treatment of early stage HCC.…”

Elektrokemoterapija – Učinkovita Metoda Zdravljenja Tumorjev S Kombinacijo Kemoterapevtika in Električnega Polja

“…srč-na mišica. [17][18][19][20][21][22][23][24][25][26][27][28] V elektrokemoterapiji služi elektroporacija kot fizikalni dostavni sistem različnih učinkovin. Na ta način elektrokemoterapija omogoča povečan vnos molekul izbranega kemoterapevtika v tumorske celice.…”

Recent Advances in Tumor Ablation for Hepatocellular Carcinoma

“…The Nanoknife ® (Angiodynamic, Latham, NY, USA) is commercially available for this purpose. Although the clinical data of IRE in the treatment of HCC are very limited, a recent study reported an 18-month recurrence-free survival for patients with unresectable HCCs treated by IRE [68].…”