Percutaneous Ablation of Hepatic Tumors Using Irreversible Electroporation: A Prospective Safety and Midterm Efficacy Study in 34 Patients

Niessen, Christoph; Beyer, Lukas Philipp; Pregler, Benedikt; Dollinger, Marco; Trabold, Benedikt; Schlitt, Hans J.; Jung, Ernst Michael; Stroszczynski, Christian; Wiggermann, Philipp

doi:10.1016/j.jvir.2015.12.025

Cited by 57 publications

(33 citation statements)

References 22 publications

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“…Although IRE is currently used as a ‘last resort treatment’ (patients would otherwise be designated to palliative treatment), efficacy results are moderate [10, 13–15]. Local tumor progression (LTP) after IRE ranges between 55 and 93% for colorectal liver metastases (CRLMs) [11].…”

Section: Introductionmentioning

confidence: 99%

Conductivity Rise During Irreversible Electroporation: True Permeabilization or Heat?

Ruarus

Vroomen

Puijk

et al. 2018

Cardiovasc Intervent Radiol

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PurposeIrreversible electroporation (IRE) induces apoptosis with high-voltage electric pulses. Although the working mechanism is non-thermal, development of secondary Joule heating occurs. This study investigated whether the observed conductivity rise during IRE is caused by increased cellular permeabilization or heat development.MethodsIRE was performed in a gelatin tissue phantom, in potato tubers, and in 30 patients with unresectable colorectal liver metastases (CRLM). Continuous versus sequential pulsing protocols (10-90 vs. 10-30-30-30) were assessed. Temperature was measured using fiber-optic probes. After temperature had returned to baseline, 100 additional pulses were delivered. The primary technique efficacy of the treated CRLM was compared to the periprocedural current rise. Seven patients received ten additional pulses after a 10-min cool-down period.ResultsTemperature and current rise was higher for the continuous pulsing protocol (medians, gel: 13.05 vs. 9.55 °C and 9 amperes (A) vs. 7A; potato: 12.70 vs. 10.53 °C and 6.0A vs. 6.5A). After cooling-down, current returned to baseline in the gel phantom and near baseline values (Δ2A with continuous- and Δ5A with sequential pulsing) in the potato tubers. The current declined after cooling-down in all seven patients with CRLM, although baseline values were not reached. There was a positive correlation between current rise and primary technique efficacy (p = 0.02); however, the previously reported current increase threshold of 12–15A was reached in 13%.ConclusionThe observed conductivity rise during IRE is caused by both cellular permeabilization and heat development. Although a correlation between current rise and efficacy exists, the current increase threshold seems unfeasible for CRLM.Electronic supplementary materialThe online version of this article (10.1007/s00270-018-1971-7) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Conductivity Rise During Irreversible Electroporation: True Permeabilization or Heat?

Ruarus

Vroomen

Puijk

et al. 2018

Cardiovasc Intervent Radiol

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“…included 10 and 43 patients, respectively, but did not specify whether the ablation was complete, nor did they provide clear results on survival. More recently, Niessen et al 28. described a rate of local recurrence of 25.2% in a serie of 34 patients in a 12-month follow-up.…”

Section: Discussionmentioning

confidence: 98%

“…To the best of our knowledge, the present study is the first to evaluate the efficacy of IRE in an animal model with nearly 6 months of follow-up and provides evidence that IRE treatment with a high electric field strength reduces tumor growth and induces a larger percentage of tumor necrosis. In most clinical studies tumor response assessment is based on RECIST criteria, as no histopathological confirmation is routinely obtained1928. A limitation of the animal study would be the lack of imaging monitoring.…”

Section: Discussionmentioning

confidence: 99%

Long-term effectiveness of irreversible electroporation in a murine model of colorectal liver metastasis

Sánchez-Velázquez

Castellví

Villanueva

et al. 2017

Sci Rep

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Irreversible electroporation (IRE) has recently gained in popularity as an ablative technique, however little is known about its oncological long-term outcomes. To determine the long-time survival of animals treated with a high dose of IRE and which histological changes it induces in tumoral tissue, IRE ablation was performed in forty-six athymic-nude mice with KM12C tumors implanted in the liver by applying electric current with different voltages (2000 V/cm, 1000 V/cm). The tumors were allowed to continue to grow until the animals reached the end-point criteria. Histology was harvested and the extent of tumor necrosis was semi-quantitatively assessed. IRE treatment with the 2000 V/cm protocol significantly prolonged median mouse survival from 74.3 ± 6.9 days in the sham group to 112.5 ± 15.2 days in the 2000 V/cm group. No differences were observed between the mean survival of the 1000 V/cm and the sham group (83.2 ± 16.4 days, p = 0.62). Histology revealed 63.05% ± 23.12 of tumor necrosis in animals of the 2000 V/cm group as compared to 17.50% ± 2.50 in the 1000 V/cm group and 25.6% ± 22.1 in the Sham group (p = 0.001). IRE prolonged the survival of animals treated with the highest electric field (2000 V/cm). The animals in this group showed significantly higher rate of tumoral necrosis.

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“…They also published results with IRE of 65 hepatic tumors, of which 33 were HCC. In this series, the authors reported an overall complication rate of 27.5% 18. Complications included the following: partial portal vein thrombosis in a cirrhotic patient requiring anti-coagulation (n=1), intraperitoneal bleed requiring intensive care unit admission and transfusion (n=1), abscess formation (n=4), hematomas (n=6), and small, clinically insignificant pneumothoraces (n=2).…”

Section: Ire For Hccmentioning

confidence: 97%

Irreversible electroporation of hepatocellular carcinoma: patient selection and perspectives

Zimmerman¹,

Grand

Charpentier³

2017

JHC

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Irreversible electroporation (IRE) is a novel form of tissue ablation that uses high-current electrical pulses to induce pore formation of the cell lipid bilayer, leading to cell death. The safety of IRE for ablation of hepatocellular carcinoma (HCC) has been established. Outcome data for ablation of HCC by IRE are limited, but early results are encouraging and suggest equivalency to the outcomes obtained for thermal ablation for appropriately selected, small (<3 cm) tumors. Long-term oncologic efficacy and histopathologic response data have not been published, and therefore, application of IRE for the treatment of HCC should still be viewed with caution.

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Percutaneous Ablation of Hepatic Tumors Using Irreversible Electroporation: A Prospective Safety and Midterm Efficacy Study in 34 Patients

Cited by 57 publications

References 22 publications

Conductivity Rise During Irreversible Electroporation: True Permeabilization or Heat?

Conductivity Rise During Irreversible Electroporation: True Permeabilization or Heat?

Long-term effectiveness of irreversible electroporation in a murine model of colorectal liver metastasis

Irreversible electroporation of hepatocellular carcinoma: patient selection and perspectives

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