Needle tract seeding following percutaneous irreversible electroporation for hepatocellular carcinoma

Abstract

Irreversible electroporation (IRE) is a non-thermal ablative technique for unresectable liver malignancies deemed unsuitable for traditional thermal ablation due to proximity to biliary and/or vascular structures. Needle tract tumour seeding is a well-recognised complication following thermal ablation, while little is known about its risk with IRE use. We present a case of tumour seeding after IRE for unresectable hepatocellular carcinoma in a man in his 70s. The procedure was complicated by bleeding from a pseudoaneurysm, which required coil embolisation and blood transfusion. He initially progressed well, however, imaging at 12 months indicated a new tumour in the right intercostal space along the tract of one of the IRE needles; consistent with seeding. Although the patient subsequently underwent systemic therapy with sorafenib, his disease progressed, and unfortunately he passed away 20 months following IRE. This report adds to mounting evidence of needle tract tumour seeding as a complication following IRE.

Pulsed Electric Fields in Oncology: A Snapshot of Current Clinical Practices and Research Directions from the 4th World Congress of Electroporation

“…Nevertheless, dedicated management guidelines have been recently developed for patients treated with TTFs on the scalp and in the thoracic region due to their relevant implications for patient QoL, adherence to the treatment schedule, and effective application of skin transducers [ 238 , 239 ]. As a safety note, compared with other PEF-based approaches using needle electrodes instead [ 240 ], TTF does not carry any risk of tumour seeding or bleeding. Importantly, as in IRE and VG-ECT, evidence suggests that results could be improved by precisely defining TTF dosimetry, implementation of rigorous treatment planning (e.g., through patient-specific computational models) and accurate delivery of TTF to the tumour bed [ 241 , 242 , 243 , 244 ].…”