Navigation Systems for Treatment Planning and Execution of Percutaneous Irreversible Electroporation

Fuhrmann, Irene; Probst, Ute; Wiggermann, Philipp; Beyer, Lukas Philipp

doi:10.1177/1533033818791792

Cited by 22 publications

(26 citation statements)

References 46 publications

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“…However, we observed a range of responses we classified as low, average, and high responses. In clinical applications of IRE, computational modeling is used to map and plan treatment for each individual patient, leading to improved ablation zone coverage [[49], [50], [51], [52]]. We did not model electrode placement in the mouse studies due to experimental limitations.…”

Section: Discussionmentioning

confidence: 99%

High-frequency irreversible electroporation is an effective tumor ablation strategy that induces immunologic cell death and promotes systemic anti-tumor immunity

et al. 2019

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Background: Despite promising treatments for breast cancer, mortality rates remain high and treatments for metastatic disease are limited. High-frequency irreversible electroporation (H-FIRE) is a novel tumor ablation technique that utilizes high-frequency bipolar electric pulses to destabilize cancer cell membranes and induce cell death. However, there is currently a paucity of data pertaining to immune system activation following H-FIRE and other electroporation based tumor ablation techniques. Methods: Here, we utilized the mouse 4T1 mammary tumor model to evaluate H-FIRE treatment parameters on cancer progression and immune system activation in vitro and in vivo. Findings: H-FIRE effectively ablates the primary tumor and induces a pro-inflammatory shift in the tumor microenvironment. We further show that local treatment with H-FIRE significantly reduces 4T1 metastases. H-FIRE kills 4T1 cells through non-thermal mechanisms associated with necrosis and pyroptosis resulting in damage associated molecular pattern signaling in vitro and in vivo. Our data indicate that the level of tumor ablation correlates with increased activation of cellular immunity. Likewise, we show that the decrease in metastatic lesions is dependent on the intact immune system and H-FIRE generates 4T1 neoantigens that engage the adaptive immune system to significantly attenuate tumor progression. Interpretation: Cell death and tumor ablation following H-FIRE treatment activates the local innate immune system, which shifts the tumor microenvironment from an anti-inflammatory state to a pro-inflammatory state. The non-thermal damage to the cancer cells and increased innate immune system stimulation improves antigen presentation, resulting in the engagement of the adaptive immune system and improved systemic anti-tumor immunity.

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Section: Discussionmentioning

confidence: 99%

High-frequency irreversible electroporation is an effective tumor ablation strategy that induces immunologic cell death and promotes systemic anti-tumor immunity

et al. 2019

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“…The key message of this study is the necessity of navigation solutions with respect to reproducibility in percutaneous, laparoscopic, and open interventions [34]. Another report investigating the accuracy between guided and manual probe placement shows a significant advantage for the guided approach [35]. Martin et al [36] discuss the advantages of computer assistance in the placement of single needles during a liver phantom study demonstrating that 95% of the participants were able to hit the center of the tumor using the computer-assisted approach compared to 65% with ultrasound (US) only.…”

Section: Computer-assisted Needle Guidancementioning

confidence: 87%

Computer Assistance in the Minimally Invasive Ablation Treatment of Pancreatic Cancer

Eigl¹,

Ανδρέου²,

Peterhans³

et al. 2021

Challenges in Pancreatic Cancer

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The insertion of ablation needles towards pancreatic tumors demands excellent anatomical knowledge and interdisciplinary skills from the medical professional. While the placement of a single needle next to the structures at risk surrounding the pancreas is considered a challenging task, irreversible electroporation requires multiple needles to be placed in parallel at a specific location. Minimally invasive procedures complicate the already ambitious procedure, yet the ablation method bears potential to increase the overall survival for patients with locally advanced pancreatic cancer. Current studies require more clinical evidence regarding the efficacy of irreversible electroporation in pancreatic cancer by means of randomized controlled, multicenter trials. However, the ablation treatment is currently applied in expert centers only, which is due to the complex task of the needle placement. Computer-assisted surgery has shown its potential in different fields of applications to improve the targeting of diseased tissue and the confidence of the medical professional. The application of computer-assisted needle navigation for pancreatic cancer ablation holds the prospect to make the procedure more reproducible and safer.

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“…Previous publications have shown that the use of a stereotactic CT-based navigation systems in placing applicators for MWA and RFA is safe and accurate 6 , 7 , 10 – 12 . Furthermore, several studies have shown the use of stereotactic navigation in IRE treatment with good results 13 – 15 .…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have proven the safety and efficacy of stereotactic CT-guidance for placement of single applicators in RFA and MWA 10 – 13 .…”

Section: Introductionmentioning

confidence: 99%

Stereotactic navigation versus ultrasound guidance in placing IRE applicators in a liver phantom

Stillström

Eigl²,

Freedman

2021

Sci Rep

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The aim of this study was to compare the accuracy of stereotactic CT-guided navigation and ultrasound guided navigation for placing electrodes in Irreversible electroporation in a liver phantom. A liver phantom with multiple tumours was used and interventionists placed four IRE electrodes around each tumour guided either by stereotactic CT-guided navigation or ultrasound. The goal was to place them in a perfect 20 × 20 mm square with parallel electrodes. After each treatment, a CT-scan was performed. The accuracy in pairwise electrode distance, pairwise parallelism and time per tumour was analysed. Eight interventionists placed four electrodes around 55 tumours, 25 with ultrasound and 30 with stereotactic CT-guided navigation. 330 electrode pairs were analysed, 150 with ultrasound and 180 with stereotactic CT-navigation. The absolute median deviation from the optimal distance was 1.3 mm (range 0.0 to 11.3 mm) in the stereotactic CT-navigation group versus 7.1 mm (range 0.3 to 18.1 mm) in the Ultrasound group (p < 0.001). The mean angle between electrodes in each pair was 2.7 degrees (95% CI 2.4 to 3.1 degrees) in the stereotactic CT-navigation group and 5.5 degrees (95% CI 5.0 to 6.1 degrees) in the Ultrasound group (p < 0.001). The mean time for placing the electrodes was 15:11 min (95% CI 13:05 to 17:18 min) in the stereotactic CT-navigation group and 6:40 min (95% CI 5:28 to 7:52 min) in the Ultrasound group. The use of stereotactic CT-navigation in placing IRE-electrodes in a liver phantom is more accurate, but more time consuming, compared to ultrasound guidance.

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Navigation Systems for Treatment Planning and Execution of Percutaneous Irreversible Electroporation

Cited by 22 publications

References 46 publications

High-frequency irreversible electroporation is an effective tumor ablation strategy that induces immunologic cell death and promotes systemic anti-tumor immunity

High-frequency irreversible electroporation is an effective tumor ablation strategy that induces immunologic cell death and promotes systemic anti-tumor immunity

Computer Assistance in the Minimally Invasive Ablation Treatment of Pancreatic Cancer

Stereotactic navigation versus ultrasound guidance in placing IRE applicators in a liver phantom

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