Irreversible Electroporation in Liver Cancers and Whole Organ Engineering

Abstract

Liver cancers contribute significantly to cancer-related mortality worldwide and liver transplants remain the cornerstone of curative treatment for select, early-stage patients. Unfortunately, because of a mismatch between demand and supply of donor organs, liver cancer patients must often wait extended periods of time prior to transplant. A variety of local therapies including surgical resection, transarterial chemoembolization, and thermal ablative methods exist in order to bridge to transplant. In recent years, a number of studies have examined the role of irreversible electroporation (IRE) as a non-thermal local ablative method for liver tumors, particularly for those adjacent to critical structures such as the vasculature, gall bladder, or bile duct. In addition to proving its utility as a local treatment modality, IRE has also demonstrated promise as a technique for donor organ decellularization in the context of whole-organ engineering. Through complete non-thermal removal of living cells, IRE allows for the creation of an acellular extra cellular matrix (ECM) scaffold that could theoretically be recellularized and implanted into a living host. Here, we comprehensively review studies investigating IRE, its role in liver cancer treatment, and its utility in whole organ engineering.

Transarterial Chemoembolization for Hepatocellular Carcinoma: Why, When, How?

“…IRE is a non-thermal ablative treatment leading to cell death by generating pulses of high voltage and intensity of short duration and creating pores in lipid bilayer of cellular membranes [ 64 ]. With this technique, the ablation is safer near vital structures due to the non-thermal energy and the probe-defined ablative zone [ 65 ]. So far, to our knowledge, only one experimental trial has been conducted studying the efficacy of combined IRE-TACE therapy.…”

Combination of Ablation and Immunotherapy for Hepatocellular Carcinoma: Where We Are and Where to Go

“…Moreover, a multicenter randomized controlled trial demonstrated that cryoablation achieved lower local tumor progression than RFA with similar OS and DFS rates ( 39 ). IRE is a non-thermal ablative technique that mediates cell damage by changing cell permeability and cellular homeostasis, which lead to cell death ( 40 ). Although IRE is a relatively new technique and few clinical studies have been conducted, its safety and efficacy have been proven ( 41 , 42 ).…”

Radiofrequency ablation with four electrodes as a building block for matrix radiofrequency ablation: Ex vivo liver experiments and finite element method modelling. Influence of electric and activation mode on coagulation size and geometry

“…Several steps still need to be taken in the development of MRFA: the current ex vivo studies have to be confirmed in in vivo studies; additional experiments are needed to study the results with electrodes that have active tips that are shorter and longer than 3 cm; and the observed reliable coagulation with 2 × 2 electrodes needs to be confirmed when using x times y electrodes. Lastly, the achievements of MRFA using a grid of multiple plain electrodes inside and outside the tumor, encompassing the tumor and a safety margin and activated in a bipolar mode, will have to be compared with the recent technique of no-touch RFA in which multiple bipolar electrodes are placed at the periphery of the tumor without piercing it [56,57,116], with other ablation methods such as microwave [128] and irreversible electroporation [129] (especially regarding efficiency near blood vessels [130]) and with stereotactic body radiotherapy [82].…”