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Zhang X, Zhang X, Ding X, Wang Z, Fan Y, Chen G, Hu X, Zheng J, Xue Z, He X, Zhang X, Wei Y, Zhang Z, Li J, Li J, Yang J, Xue X, Ma L, Xiao Y. Novel irreversible electroporation ablation (Nano-knife) versus radiofrequency ablation for the treatment of solid liver tumors: a comparative, randomized, multicenter clinical study. Front Oncol 2022; 12:945123. [PMID: 36249062 PMCID: PMC9557230 DOI: 10.3389/fonc.2022.945123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022] Open
Abstract
Irreversible electroporation (IRE) is a soft tissue ablation technique that uses short electrical fields which induce the death of target cells. To evaluate the safety and efficacy of an IRE-based device compared to regular radiofrequency ablation (RFA) of solid liver tumors, in this multicenter, randomized, parallel-arm, non-inferiority study, 152 patients with malignant liver tumors were randomized into IRE (n = 78) and RFA (n = 74) groups. The primary endpoint was the success rate of tumor ablation; the secondary endpoints included the tumor ablation time, complications, tumor recurrence rates and treatment-related adverse events (TRAE). The success rate of tumor ablation using IRE was 94.9% and was non-inferior to the RFA group (96.0%) (P = 0.761). For the secondary endpoints, the average ablation time was 34.29 ± 30.38 min for the IRE group, which was significantly longer than for the RFA group (19.91 ± 16.08 min) (P < 0.001). The incidences of postoperative complications after 1 week (P = 1.000), 1 month (P = 0.610) and 3 months (P = 0.490) were not significantly different between the 2 groups. The recurrence rates of liver tumor at 1, 3 and 6 months after ablation were 0 (0.0%), 10 (13.9%) and 10 (13.3%) in the IRE group and 2.9%, 7.3% and 19.7% in the RFA control group (all P > 0.05), respectively. For safety assessments, 51 patients experienced 191 AEs (65.4%) in the IRE group, which was not different from the RFA group (73.0%, 54/184) (P = 0.646). In 7 IRE patients, 8 TRAEs (7.9%) occurred, the most common being edema of the limbs (mild grade) and fever (severe grade), while no TRAEs occurred in the RFA group. This study proved that the excellent safety and efficacy of IRE was non-inferior to the regular radiofrequency device in ablation performance for the treatment of solid liver tumors. Clinical trial registration: Chinese Clinical Trial Registry: ChiCTR1800017516
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Affiliation(s)
- Xiaobo Zhang
- Department of Radiology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Xiao Zhang
- Department of Radiology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaoyi Ding
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongmin Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Fan
- Department of Medical Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Guang Chen
- Department of Radiology, Tianjin First Central Hospital, Tianjin, China
| | - Xiaokun Hu
- Department of Interventional Radiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jiasheng Zheng
- Center of Interventional Oncology and Liver Diseases, Beijing Youan Hospital, Beijing, China
| | - Zhixiao Xue
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Xiaofeng He
- Department of Radiology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xin Zhang
- Department of Radiology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yingtian Wei
- Department of Radiology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhongliang Zhang
- Department of Radiology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jing Li
- Department of Radiology, Characteristic Medical Center of Chinese People’s Armed Police Force, Tianjin, China
| | - Jie Li
- Department of Radiology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jie Yang
- Department of Radiology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaodong Xue
- Department of Radiology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Li Ma
- Department of Anesthesiology, First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yueyong Xiao
- Department of Radiology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
- *Correspondence: Yueyong Xiao,
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Percutaneous Ablation of Hepatic Tumors at the Hepatocaval Confluence Using Irreversible Electroporation: A Preliminary Study. Curr Oncol 2022; 29:3950-3961. [PMID: 35735425 PMCID: PMC9221598 DOI: 10.3390/curroncol29060316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 01/04/2023] Open
Abstract
Background: Tumors at the hepatocaval confluence are difficult to treat, either surgically or ablatively. Methods: A retrospective longitudinal study on patients ineligible for thermal ablation who underwent computed tomography-guided IRE for hepatic tumors at the hepatocaval confluence was conducted. Factors analyzed included patient and tumor characteristics, IRE procedure details, treatment-related complications, and prognosis. Results: Between 2017 and 2021, 21 patients at our institute received percutaneous IRE. Of the 38 lesions, 21 were at the hepatocaval confluence. Complete ablation was achieved in all cases. Local and distant recurrence was observed in 4.8% (1/21) and 42.6% (9/21) of the ablated tumors, respectively. All postcava remained perfused at follow-up, except for 1 (4.8%) hepatic vein near the lesion found to be temporarily occluded and restored within 1 month. The ratio of the maximum diameter of ablation area at 1, 3, and 6 months post procedure compared to that immediately after IRE was 0.68 (0.50–0.84), 0.49 (0.27–0.61), and 0.38 (0.25–0.59), respectively. Progression-free survival of the patients with recurrence was 121 (range, 25–566) days. Four (19.0%) patients died at the end of follow-up with median overall survival of 451.5 (range, 25–716) days. Conclusions: IRE could be a safe and effective treatment for hepatic tumors at the hepatocaval confluence. This article provides valuable prognostic data; further clinical research is needed for better prognosis.
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Ruarus AH, Barabasch A, Catalano O, Leen E, Narayanan G, Nilsson A, Padia SA, Wiggermann P, Scheffer HJ, Meijerink MR. Irreversible Electroporation for Hepatic Tumors: Protocol Standardization Using the Modified Delphi Technique. J Vasc Interv Radiol 2020; 31:1765-1771.e15. [PMID: 32978054 DOI: 10.1016/j.jvir.2020.02.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 02/06/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE A consensus study of panelists was performed to provide a uniform protocol regarding (contra) indications, procedural parameters, perioperative care, and follow-up of irreversible electroporation (IRE) for the treatment of hepatic malignancies. MATERIALS AND METHODS Interventional radiologists who had 2 or more publications on IRE, reporting at least 1 patient cohort in the field of hepatobiliary IRE, were recruited. The 8 panelists were asked to anonymously complete 3 iterative rounds of IRE-focused questionnaires to collect data according to a modified Delphi technique. Consensus was defined as having reached 80% or greater agreement. RESULTS Panel members' response rates were 88%, 75%, and 88% in rounds 1, 2, and 3, respectively; consensus was reached on 124 of 136 items (91%). Percutaneous or intraoperative hepatic IRE should be considered for unresectable primary and secondary malignancies that are truly unsuitable for thermal ablation because of proximity to critical structures. Absolute contraindications are ventricular arrhythmias, cardiac stimulation devices, and congestive heart failure of New York Heart Association class 3 or higher. A metal stent outside the ablation zone should not be considered a contraindication. For the only commercially available IRE device, the recommended settings are an inter-electrode distance of 10-20 mm and an exposure length of 20 mm. After 10 test pulses, 90 treatment pulses of 1500 V/cm should be delivered continuously, with a pulse length of 70-90 μs. The first post-procedural follow-up should take place 1 month after IRE and thereafter every 3 months, using cross-sectional imaging plus tumor marker assessment. CONCLUSIONS This article provides recommendations, created by a modified Delphi consensus study, regarding patient selection, workup, procedure, and follow-up of IRE treatment for hepatic malignancies.
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Affiliation(s)
- Alette H Ruarus
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Alexandra Barabasch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Orlando Catalano
- Department of Radiology, Istituto Nazionale Tumori Fondazione G.Pascale, Naples, Italy
| | - Edward Leen
- Department of Experimental Medicine, Imperial College London, London, United Kingdom
| | - Govindarajan Narayanan
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Florida
| | - Anders Nilsson
- Department of Medical Imaging and Physiology, Lund University Hospital, Lund, Sweden
| | - Siddharth A Padia
- Department of Radiology, University of California Los Angeles, Los Angeles, California
| | - Philipp Wiggermann
- Department of Radiology and Nuclear Medicine, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Hester J Scheffer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Martijn R Meijerink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Radiological findings of porcine liver after electrochemotherapy with bleomycin. Radiol Oncol 2019; 53:415-426. [PMID: 31600140 PMCID: PMC6884938 DOI: 10.2478/raon-2019-0049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/12/2019] [Indexed: 12/11/2022] Open
Abstract
Background Radiologic findings after electrochemotherapy of large hepatic blood vessels and healthy hepatic parenchyma have not yet been described. Materials and methods We performed a prospective animal model study with regulatory approval, including nine grower pigs. In each animal, four ultrasound-guided electroporated regions were created; in three regions, electrodes were inserted into the lumen of large hepatic vessels. Two types of electrodes were tested; variable linear- and fixed hexagonal-geometry electrodes. Ultrasonographic examinations were performed immediately and up to 20 minutes after the procedure. Dynamic computed tomography was performed before and at 60 to 90 minutes and one week after the procedure. Results Radiologic examinations of the treated areas showed intact vessel walls and patency; no hemorrhage or thrombi were noted. Ultrasonographic findings were dynamic and evolved from hyperechogenic microbubbles along electrode tracks to hypoechogenicity of treated parenchyma, diffusion of hyperechogenic microbubbles, and hypoechogenicity fading. Contrast-enhanced ultrasound showed decreased perfusion of the treated area. Dynamic computed tomography at 60 to 90 minutes after the procedure showed hypoenhancing areas. The total hypoenhancing area was smaller after treatment with fixed hexagonal electrodes than after treatment with variable linear geometry electrodes. Conclusions Radiologic findings of porcine liver after electrochemotherapy with bleomycin did not show clinically significant damage to the liver, even if a hazardous treatment strategy, such as large vessel intraluminal electrode insertion, was employed, and thus further support safety and clinical use of electrochemotherapy for treatment of hepatic neoplasia.
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Chakedis J, Squires MH, Beal EW, Hughes T, Lewis H, Paredes A, Al-Mansour M, Sun S, Cloyd JM, Pawlik TM. Update on current problems in colorectal liver metastasis. Curr Probl Surg 2017; 54:554-602. [PMID: 29198365 DOI: 10.1067/j.cpsurg.2017.10.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jeffrey Chakedis
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Malcolm H Squires
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Eliza W Beal
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Tasha Hughes
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Heather Lewis
- University of Colorado Health System, Fort Collins, CO
| | - Anghela Paredes
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Mazen Al-Mansour
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Steven Sun
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Jordan M Cloyd
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Timothy M Pawlik
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH.
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Habibian DJ, Katz AE. Emerging minimally invasive procedures for focal treatment of organ-confined prostate cancer. Int J Hyperthermia 2016; 32:795-800. [PMID: 27362886 DOI: 10.1080/02656736.2016.1195925] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Prostate cancer is the most common malignancy amongst American men. However, the majority of prostate cancer diagnoses are of low risk, organ-confined disease. Many men elect to undergo definitive treatment, but may benefit from focal therapy to maintain continence and potency. This review reports the mechanism of action and outcomes of emerging focal therapies for prostate cancer. We report the mechanism of action of focal cryotherapy, high intensity focused ultrasound, focal laser ablation, and irreversible electroporation. In addition, we reviewed the largest studies available reporting rates of urinary incontinence, erectile dysfunction, biochemical recurrence-free survival (ASTRO), and post-operative adverse events for each procedure. Each treatment modality stated has a unique mechanism in the ablation of cancerous cells. Genito-urinary symptoms following these studies report incontinence and erectile dysfunction rates ranging from 0-15% and 0-53%, respectively. Biochemical disease-free survival was reported using the ASTRO definition. Some treatment modalities lack the necessary follow-up to determine effectiveness in cancer control. No focal therapy studies reported serious adverse events. These minimally invasive procedures are feasible in a clinical setting and show promising functional and disease control results with short to medium-term follow-up. However, each treatment requires additional robust prospective studies as well as its own unique domain to determine biochemical recurrence free survival to properly determine their role in treatment of organ-confined prostate cancer.
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Affiliation(s)
- David J Habibian
- a Department of Urology , Winthrop University Hospital , Mineola , New York , USA
| | - Aaron E Katz
- a Department of Urology , Winthrop University Hospital , Mineola , New York , USA
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Guo Y, Zhang Y, Huang J, Chen X, Huang W, Shan H, Zhu K. Safety and Efficacy of Transarterial Chemoembolization Combined with CT-Guided Radiofrequency Ablation for Hepatocellular Carcinoma Adjacent to the Hepatic Hilum within Milan Criteria. J Vasc Interv Radiol 2016; 27:487-95. [PMID: 26922006 DOI: 10.1016/j.jvir.2016.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 12/09/2015] [Accepted: 01/01/2016] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To retrospectively evaluate safety and efficacy of conventional transarterial chemoembolization with ethiodized oil (Lipiodol) combined with CT-guided radiofrequency (RF) ablation for hepatocellular carcinoma (HCC) adjacent to the hepatic hilum. MATERIALS AND METHODS Between January 2007 and December 2010, conventional transarterial chemoembolization combined with CT-guided RF ablation was performed in 40 patients with HCC adjacent to the hepatic hilum within Milan criteria (group A). Major complications, complete tumor ablation rate, local tumor progression rate, and overall survival were compared with 107 patients with HCC nonadjacent to the hepatic hilum (group B) treated by conventional transarterial chemoembolization combined with CT-guided RF ablation during the same period. RESULTS Major complications included one case of large hepatic artery-portal vein fistula in group A (2.5%; 1/40) and one case of acute portal vein thrombosis, left heart failure, and tumor seeding in group B (2.8%; 3/107); the difference was not significant between the two groups (P = 1.000). There were no significant differences between the two groups in complete tumor ablation rate (80.0% vs 86.0%; P = .374), local tumor progression rates (1-year, 12.5% vs 14.1%; 2-year, 28.2% vs 24.2%; 3-year, 32.0% vs 27.6%; P = .723), and overall survival (1-year, 92.3% vs 91.8%; 3-year, 79.1% vs 79.3%; 5-year, 59.5% vs 58.4%; P = .555). CONCLUSIONS Conventional transarterial chemoembolization combined with CT-guided RF ablation was safe and effective in selected patients with HCC adjacent to the hepatic hilum within Milan criteria.
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Affiliation(s)
- Yongjian Guo
- Department of Radiology, 600 Tianhe Road, Guangzhou, Guangdong 510630, China; Department of Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ying Zhang
- Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong 510630, China
| | - Jingjun Huang
- Department of Radiology, 600 Tianhe Road, Guangzhou, Guangdong 510630, China; Department of Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiuzheng Chen
- Department of Radiology, 600 Tianhe Road, Guangzhou, Guangdong 510630, China; Department of Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wensou Huang
- Department of Radiology, 600 Tianhe Road, Guangzhou, Guangdong 510630, China; Department of Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hong Shan
- Department of Radiology, 600 Tianhe Road, Guangzhou, Guangdong 510630, China; Department of Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Kangshun Zhu
- Department of Radiology, 600 Tianhe Road, Guangzhou, Guangdong 510630, China; Department of Interventional Radiology Institute, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Lee PC, Peng CL, Shieh MJ. Combining the single-walled carbon nanotubes with low voltage electrical stimulation to improve accumulation of nanomedicines in tumor for effective cancer therapy. J Control Release 2016; 225:140-51. [PMID: 26812005 DOI: 10.1016/j.jconrel.2016.01.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 01/15/2016] [Accepted: 01/21/2016] [Indexed: 12/26/2022]
Abstract
Effective delivery of biomolecules or functional nanoparticles into target sites has always been the primary objective for cancer therapy. We demonstrated that by combining single-walled carbon nanotubes (SWNTs) with low-voltage (LV) electrical stimulation, biomolecule delivery can be effectively enhanced through reversible electroporation (EP). Clear pore formation in the cell membrane is observed due to LV (50V) pulse electrical stimulation amplified by SWNTs. The cell morphology remains intact and high cell viability is retained. This modality of SWNT + LV pulses can effectively transfer both small molecules and macromolecules into cells through reversible EP. The results of animal studies also suggest that treatment with LV pulses alone cannot increase vascular permeability in tumors unless after the injection of SWNTs. The nanoparticles can cross the permeable vasculature, which enhances their accumulation in the tumor tissue. Therefore, in cancer treatment, both SWNT + LV pulse treatment followed by the injection of LIPO-DOX® and SWNT/DOX + LV pulse treatment can increase tumor inhibition and delay tumor growth. This novel treatment modality applied in a human cancer xenograft model can provide a safe and effective therapy using various nanomedicines in cancer treatment.
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Affiliation(s)
- Pei-Chi Lee
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei 100, Taiwan
| | - Cheng-Liang Peng
- Isotope Application Division, Institute of Nuclear Energy Research, P.O. Box 3-27, Longtan, Taoyuan 325, Taiwan.
| | - Ming-Jium Shieh
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei 100, Taiwan; Department of Oncology, National Taiwan University Hospital and College of Medicine, #7, Chung-Shan South Road, Taipei 100, Taiwan.
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Eisele RM, Chopra SS, Glanemann M, Gebauer B. Risk of local failure after ultrasound guided irreversible electroporation of malignant liver tumors. Interv Med Appl Sci 2014; 6:147-53. [PMID: 25598987 DOI: 10.1556/imas.6.2014.4.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/29/2014] [Accepted: 09/03/2014] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Irreversible electroporation (IRE) is considered superior to thermoablations for tumors in the vicinity of larger vessels and the liver hilum. We report on an initial clinical experience of IRE. MATERIALS AND METHODS Indications included focal liver lesions <3 cm, irresectability due to contraindications and expected complications and/or irradicality following radiofrequency ablation (RFA). Ultrasound was chosen for guidance and needle placement. RESULTS IRE was intended to perform in 14 patients with 1 procedure aborted due to technical failure. Among the 13 successfully treated were 7 percutaneous, 4 laparoscopic, and 2 open surgical procedures. The average age was 63 ± 10 years. Twelve solitary nodules and one bifocal disease were treated with an average size of 1.5 cm ± 0.5 cm. Median follow-up was 6 months. Three incomplete ablations account for 21% (3/14), 2 of them occurring in 2 metastases larger than 2 cm percutaneously treated with 5 needles instead of 4 used for smaller tumor sizes. CONCLUSION IRE was introduced without difficulties into clinical practice. As a main obstacle emerged in visualization of the needles, computed tomography may offer advantages in the guidance of percutaneous IRE of liver metastases larger than 2 cm. Local failure occurred in 21%.
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Månsson C, Nilsson A, Karlson BM. Severe complications with irreversible electroporation of the pancreas in the presence of a metallic stent: a warning of a procedure that never should be performed. Acta Radiol Short Rep 2014; 3:2047981614556409. [PMID: 25535573 PMCID: PMC4271709 DOI: 10.1177/2047981614556409] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/26/2014] [Indexed: 12/14/2022] Open
Abstract
Irreversible electroporation (IRE) is an ablation technique that is being investigated as a potential treatment of pancreatic cancer. However, many of these patients have a metallic stent in the bile duct, which is recognized as a contraindication for IRE ablation. We report a case in which an IRE ablation in the region of the pancreatic head was performed on a patient with a metallic stent which led to severe complications. After the treatment, the patient suffered from several complications including perforation of the duodenum and transverse colon, and bleeding from a branch of the superior mesenteric artery which eventually lead to her death. Therefore, we believe it is important to be aware of this if an IRE ablation close to a metallic stent is considered.
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Affiliation(s)
| | - Anders Nilsson
- Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala, Sweden
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Desolneux G, Vara J, Razafindratsira T, Isambert M, Brouste V, McKelvie-Sebileau P, Evrard S. Patterns of complications following intraoperative radiofrequency ablation for liver metastases. HPB (Oxford) 2014; 16:1002-8. [PMID: 24830798 PMCID: PMC4487751 DOI: 10.1111/hpb.12274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/07/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intraoperative radiofrequency ablation (IRFA) is added to surgery to obtain hepatic clearance of liver metastases. Complications occurring in IRFA should differ from those associated with wedge or anatomic liver resection. METHODS Patients with liver metastases treated with IRFA from 2000 to 2010 were retrospectively analysed. Postoperative outcomes are reported according to the Clavien-Dindo system of classification. RESULTS A total of 151 patients underwent 173 procedures for 430 metastases. Of these, 97 procedures involved IRFA plus liver resection and 76 involved IRFA only. The median number of lesions treated by IRFA was two (range: 1-11). A total of 123 (71.1%) procedures were carried out in patients who had received preoperative chemotherapy. The mortality rate was 1.2%. Thirty (39.5%) IRFA-only patients and 45 (46.4%) IRFA-plus-resection patients presented complications. Immediate complications (n = 4) were associated with IRFA plus resection. American Society of Anesthesiologists (ASA) class, previous abdominal surgery or hepatic resection, body mass index, number of IRFA procedures, portal pedicle clamping, total vascular exclusion and preoperative chemotherapy were not associated with a greater number of complications of Grade III or higher severity. Length of surgery >4 h [odds ratio (OR) 2.67, 95% confidence interval (CI) 1.1-6.3; P < 0.05] and an associated contaminating procedure (OR 3.72, 95% CI 1.53-9.06; P < 0.005) led to a greater frequency of complications of Grade III or higher. CONCLUSIONS Mortality and morbidity after IRFA, with or without resection, are low. Nevertheless, long interventions and concurrent bowel operations increase the risk for septic complications.
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Affiliation(s)
| | - Jeremy Vara
- Digestive Tumour Unit, Institut BergoniéBordeaux, France
| | | | | | - Véronique Brouste
- Clinical and Epidemiological Research Unit, Institut BergoniéBordeaux, France
| | | | - Serge Evrard
- Digestive Tumour Unit, Institut BergoniéBordeaux, France,University of BordeauxBordeaux, France,Correspondence, Serge Evrard, Digestive Tumour Unit, Institut Bergonié, 229 Cours de l’Argonne, 33076 Bordeaux, France. Tel: + 33 5 56 33 32 61. Fax: + 33 5 56 33 33 83. E-mail:
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van den Bos W, de Bruin DM, Muller BG, Varkarakis IM, Karagiannis AA, Zondervan PJ, Laguna Pes MP, Veelo DP, Savci Heijink CD, Engelbrecht MRW, Wijkstra H, de Reijke TM, de la Rosette JJMCH. The safety and efficacy of irreversible electroporation for the ablation of prostate cancer: a multicentre prospective human in vivo pilot study protocol. BMJ Open 2014; 4:e006382. [PMID: 25354827 PMCID: PMC4216863 DOI: 10.1136/bmjopen-2014-006382] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Current surgical and ablative treatment options for prostate cancer have a relatively high incidence of side effects, which may diminish the quality of life. The side effects are a consequence of procedure-related damage of the blood vessels, bowel, urethra or neurovascular bundle. Ablation with irreversible electroporation (IRE) has shown to be effective in destroying tumour cells and harbours the advantage of sparing surrounding tissue and vital structures. The aim of the study is to evaluate the safety and efficacy and to acquire data on patient experience of minimally invasive, transperineally image-guided IRE for the focal ablation of prostate cancer. METHODS AND ANALYSIS In this multicentre pilot study, 16 patients with prostate cancer who are scheduled for a radical prostatectomy will undergo an IRE procedure, approximately 30 days prior to the radical prostatectomy. Data as adverse events, side effects, functional outcomes, pain and quality of life will be collected and patients will be controlled at 1 and 2 weeks post-IRE, 1 day preprostatectomy and postprostatectomy. Prior to the IRE procedure and the radical prostatectomy, all patients will undergo a multiparametric MRI and contrast-enhanced ultrasound of the prostate. The efficacy of ablation will be determined by whole mount histopathological examination, which will be correlated with the imaging of the ablation zone. ETHICS AND DISSEMINATION The protocol is approved by the ethics committee at the coordinating centre (Academic Medical Center (AMC) Amsterdam) and by the local Institutional Review Board at the participating centres. Data will be presented at international conferences and published in peer-reviewed journals. CONCLUSIONS This pilot study will determine the safety and efficacy of IRE in the prostate. It will show the radiological and histopathological effects of IRE ablations and it will provide data to construct an accurate treatment planning tool for IRE in prostate tissue. TRIAL REGISTRATION NUMBER Clinicaltrials.gov database: NCT01790451.
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Affiliation(s)
- W van den Bos
- Department of Urology, Department of Biomedical Engineering & Physics, Department of Anesthesiology, Department of Pathology, Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - D M de Bruin
- Department of Urology, Department of Biomedical Engineering & Physics, Department of Anesthesiology, Department of Pathology, Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - B G Muller
- Department of Urology, Department of Biomedical Engineering & Physics, Department of Anesthesiology, Department of Pathology, Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - I M Varkarakis
- 2nd Department of Urology, Athens Medical University, University of Athens, Athens, Greece
| | - A A Karagiannis
- 2nd Department of Urology, Athens Medical University, University of Athens, Athens, Greece
| | - P J Zondervan
- Department of Urology, Department of Biomedical Engineering & Physics, Department of Anesthesiology, Department of Pathology, Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Laguna Pes
- Department of Urology, Department of Biomedical Engineering & Physics, Department of Anesthesiology, Department of Pathology, Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - D P Veelo
- Department of Urology, Department of Biomedical Engineering & Physics, Department of Anesthesiology, Department of Pathology, Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - C D Savci Heijink
- Department of Urology, Department of Biomedical Engineering & Physics, Department of Anesthesiology, Department of Pathology, Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M R W Engelbrecht
- Department of Urology, Department of Biomedical Engineering & Physics, Department of Anesthesiology, Department of Pathology, Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - H Wijkstra
- Department of Urology, Department of Biomedical Engineering & Physics, Department of Anesthesiology, Department of Pathology, Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - T M de Reijke
- Department of Urology, Department of Biomedical Engineering & Physics, Department of Anesthesiology, Department of Pathology, Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J J M C H de la Rosette
- Department of Urology, Department of Biomedical Engineering & Physics, Department of Anesthesiology, Department of Pathology, Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Tumor Ablation for Treatment of Colorectal Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2014. [DOI: 10.1007/s11888-014-0214-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Eller A, Schmid A, Schmidt J, May M, Brand M, Saake M, Uder M, Lell M. Local control of perivascular malignant liver lesions using percutaneous irreversible electroporation: initial experiences. Cardiovasc Intervent Radiol 2014; 38:152-9. [PMID: 24798135 DOI: 10.1007/s00270-014-0898-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/21/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE This study was designed to assess efficacy and safety in the treatment of perivascular malignant liver lesions using percutaneous, computed tomography (CT)-guided irreversible electroporation (IRE). METHODS Fourteen patients (mean age 58 ± 11 years) with 18 malignant liver lesions were consecutively enrolled in this study. IRE was performed in patients not eligible for surgery and lesions abutting large vessels or bile ducts. Follow-up exams were performed using multislice-CT (MS-CT) or MRI. RESULTS Medium lesion diameter was 20 ± 5 mm. Ten of 14 (71 %) were successfully treated with no local recurrence to date (mean follow-up 388 ± 160 days). One case left initial tumor control unclear and additional RFA was performed 4 weeks after IRE. Complications occurred in 4 of 14 (29 %) cases. In one case, intervention was terminated and abdominal bleeding required laparotomy. In two cases, a postinterventional hematothorax required intervention. In another case, abdominal bleeding could be managed conservatively. No complications related to the bile ducts occurred. CONCLUSIONS Percutaneous IRE seems to be effective in perivascular lesions but is associated with a higher complication rate compared with thermoablative techniques.
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Affiliation(s)
- Achim Eller
- Department of Radiology, University Hospital Erlangen, University of Erlangen-Nuremberg, Maximiliansplatz 1, 91054, Erlangen, Germany,
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15
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Scheffer HJ, Nielsen K, de Jong MC, van Tilborg AAJM, Vieveen JM, Bouwman ARA, Meijer S, van Kuijk C, van den Tol PMP, Meijerink MR. Irreversible electroporation for nonthermal tumor ablation in the clinical setting: a systematic review of safety and efficacy. J Vasc Interv Radiol 2014; 25:997-1011; quiz 1011. [PMID: 24656178 DOI: 10.1016/j.jvir.2014.01.028] [Citation(s) in RCA: 268] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 01/07/2014] [Accepted: 01/23/2014] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To provide an overview of current clinical results of irreversible electroporation (IRE), a novel, nonthermal tumor ablation technique that uses electric pulses to induce cell death, while preserving structural integrity of bile ducts and vessels. METHODS All in-human literature on IRE reporting safety or efficacy or both was included. All adverse events were recorded. Tumor response on follow-up imaging from 3 months onward was evaluated. RESULTS In 16 studies, 221 patients had 325 tumors treated in liver (n = 129), pancreas (n = 69), kidney (n = 14), lung (n = 6), lesser pelvis (n = 1), and lymph node (n = 2). No major adverse events during IRE were reported. IRE caused only minor complications in the liver; however, three major complications were reported in the pancreas (bile leak [n = 2], portal vein thrombosis [n = 1]). Complete response at 3 months was 67%-100% for hepatic tumors (93%-100% for tumors o 3 cm). Pancreatic IRE combined with surgery led to prolonged survival compared with control patients (20 mo vs 13 mo) and significant pain reduction. CONCLUSIONS In cases where other techniques are unsuitable, IRE is a promising modality for the ablation of tumors near bile ducts and blood vessels. This articles gives an extensive overview of the available evidence, which is limited in terms of quality and quantity. With the limitations of the evidence in mind, IRE of central liver tumors seems relatively safe without major complications, whereas complications after pancreatic IRE appear more severe. The available limited results for tumor control are generally good. Overall, the future of IRE for difficult-to-reach tumors appears promising.
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Affiliation(s)
- Hester J Scheffer
- Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
| | - Karin Nielsen
- Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Marcus C de Jong
- Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Aukje A J M van Tilborg
- Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Jenny M Vieveen
- Department of Anesthesiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Arthur R A Bouwman
- Department of Anesthesiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Sybren Meijer
- Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Cornelis van Kuijk
- Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Petrousjka M P van den Tol
- Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Martijn R Meijerink
- Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
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Introduction of Genes via Sonoporation and Electroporation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 818:231-54. [DOI: 10.1007/978-1-4471-6458-6_12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Evrard S, Brouste V, McKelvie-Sebileau P, Desolneux G. Liver metastases in close contact to hepatic veins ablated under vascular exclusion. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2013; 39:1400-6. [PMID: 24095104 DOI: 10.1016/j.ejso.2013.08.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/20/2013] [Accepted: 08/24/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Liver metastases (LM) in close contact to hepatic veins (HV) are a frequent cause of unresectability. Reconstruction of hepatic veins is technically difficult and outcomes are poor. Intra-operative radiofrequency ablation (IRFA) with vascular exclusion (VE) may be a useful approach. METHODS Out of 358 patients operated for LM, 22 with LM close to a HV treated by IRFA under VE with at least one year of follow-up were included in this retrospective study. Technical success was evaluated at four months by CT scan of the ablated lesion. Complications; local, hepatic and extra-hepatic recurrence rates, and overall survival are reported. RESULTS The median number of metastases was 4.5 [range: 1-12]. Seventeen patients had bilateral metastases. The median size of ablated lesions was 2 cm [range: 1-5.5]. Seven complications occurred (1 Grade 1, 2 Grade 3b and 4 Grade IVa), with no mortality. No recurrence of ablated lesions was detected at four months or during follow-up. Seventeen patients had new or extra-hepatic lesions. Median overall survival for colorectal patients was 40 months 95%CI[17.5-not reached]. CONCLUSIONS IRFA plus VE for LM in close contact to a HV is a novel approach, appearing to be a safe and effective technique which can extend the applications of liver metastases surgery.
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Affiliation(s)
- S Evrard
- Digestive Tumours Unit, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France; Université Bordeaux Segalen, 166 cours de l'Argonne, 33076 Bordeaux, France.
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Kasivisvanathan V, Emberton M, Ahmed HU. Focal therapy for prostate cancer: rationale and treatment opportunities. Clin Oncol (R Coll Radiol) 2013; 25:461-73. [PMID: 23759249 PMCID: PMC4042323 DOI: 10.1016/j.clon.2013.05.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 03/21/2013] [Accepted: 05/08/2013] [Indexed: 01/20/2023]
Abstract
Focal therapy is an emerging treatment modality for localised prostate cancer that aims to reduce the morbidity seen with radical therapy, while maintaining cancer control. Focal therapy treatment strategies minimise damage to non-cancerous tissue, with priority given to the sparing of key structures such as the neurovascular bundles, external sphincter, bladder neck and rectum. There are a number of ablative technologies that can deliver energy to destroy cancer cells as part of a focal therapy strategy. The most widely investigated are cryotherapy and high-intensity focussed ultrasound. Existing radical therapies, such as brachytherapy and external beam radiotherapy, also have the potential to be applied in a focal manner. The functional outcomes of focal therapy from several phase I and II trials have been encouraging, with low rates of urinary incontinence and erectile dysfunction. Robust medium- and long-term cancer control outcomes are currently lacking. Controversies in focal therapy remain, notably treatment paradigms based on the index lesion hypothesis, appropriate patient selection for focal therapy and how the efficacy of focal therapy should be assessed. This review articles discusses the current status of focal therapy, highlighting controversies and emerging strategies that can influence treatment outcomes for the future.
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Affiliation(s)
- V Kasivisvanathan
- Division of Surgery and Interventional Sciences, University College London, UK.
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