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Xu M, Xie LT, Xiao YY, Liang P, Zhao QY, Wang ZM, Chai WL, Wei YT, Xu LF, Hu XK, Kuang M, Niu LZ, Yao CG, Kong HY, Tian G, Xie XY, Cui XW, Xu D, Zhao J, Jiang TA. Chinese clinical practice guidelines for ultrasound-guided irreversible electroporation of liver cancer (version 2022). Hepatobiliary Pancreat Dis Int 2022; 21:462-471. [PMID: 36058782 DOI: 10.1016/j.hbpd.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Min Xu
- Department of Ultrasound Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, Zhejiang 310003, China
| | - Li-Ting Xie
- Department of Ultrasound Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, Zhejiang 310003, China
| | - Yue-Yong Xiao
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing 100000, China
| | - Ping Liang
- Department of Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Qi-Yu Zhao
- Department of Ultrasound Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, Zhejiang 310003, China
| | - Zhong-Min Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Wei-Lu Chai
- Department of Ultrasound Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, Zhejiang 310003, China
| | - Ying-Tian Wei
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing 100000, China
| | - Lin-Feng Xu
- Department of Interventional Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
| | - Xiao-Kun Hu
- Department of the Interventional Medical Center, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Ming Kuang
- Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Li-Zhi Niu
- Department of Oncology, Affiliated Fuda Cancer Hospital, Jinan University, Guangzhou 510665, China
| | - Chen-Guo Yao
- School of Electrical Engineering, Chongqing University, Chongqing 400033, China
| | - Hai-Ying Kong
- Department of Anesthesiology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Guo Tian
- Department of Ultrasound Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, Zhejiang 310003, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Dong Xu
- Department of Interventional Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, China
| | - Jun Zhao
- Department of Anatomy, School of Basic Medicine, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Tian-An Jiang
- Department of Ultrasound Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, Zhejiang 310003, China.
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Kawamura I, Reddy VY, Wang BJ, Dukkipati SR, Chaudhry HW, Santos-Gallego CG, Koruth JS. Pulsed Field Ablation of the Porcine Ventricle Using a Focal Lattice-Tip Catheter. Circ Arrhythm Electrophysiol 2022; 15:e011120. [PMID: 36074657 PMCID: PMC9794124 DOI: 10.1161/circep.122.011120] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Our understanding of catheter-based pulsed field ablation (PFA) of the ventricular myocardium is limited. We conducted a series of exploratory evaluations of ventricular PFA in swine ventricles. METHODS A focal lattice-tip catheter was used to deliver proprietary biphasic monopolar PFA applications to swine ventricles under general anesthesia, with guidance from electroanatomical mapping, fluoroscopy, and intracardiac echocardiography. We conducted experiments to assess the impact of (1) delivery repetition (2×, 3×, or 4×) at each location, (2) epicardial PFA delivery, and (3) confluent areas of shallow healed endocardial scar created by prior PFA (4 weeks earlier) on subsequent endocardial PFA. Additional assessments included PFA optimized for the ventricle, lesion visualization by intracardiac echocardiography imaging, and immunohistochemical insights. RESULTS Experiment no. 1: lesions (n=49) were larger with delivery repetition of either 4× or 3× versus 2×: length 17.6±3.9 or 14.2±2.0 versus 12.7±2.0 mm (P<0.01, P=0.22), width 13.4±1.8 or 10.6±1.3 versus 10.5±1.1 mm (P<0.01, P=1.00), and depth 6.1±2.1 or 5.1±1.3 versus 4.2±1.0 mm (P<0.01, P=0.21). Experiment no. 2: epicardial lesions (n=18) were reliably created and comparable to endocardial lesions: length 24.6±9.7 mm (n=5), width 15.6±4.6 mm, and depth 4.5±3.7 mm. Experiment no. 3: PFA (n=16) was able to penetrate to a depth of 4.8 (interquartile range, 4.5-5.4) mm in healthy myocardium versus 5.6 (interquartile range, 3.6-6.6) mm in adjacent healed endocardial scar (P=0.79), suggesting that superficial scar does not significantly impair PFA. Finally, we demonstrate, PFA optimized for the ventricle yielded adequate lesion dimensions, can result in myocardial activation, can be visualized by intracardiac echocardiography, and have unique immunohistochemical characteristics. CONCLUSIONS This in vivo evaluation offers insights into the behavior of endocardial or epicardial PFA delivered using the lattice-tip catheter to normal or scarred porcine ventricular myocardium, thereby setting the stage for future clinical studies.
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Affiliation(s)
- Iwanari Kawamura
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vivek Y. Reddy
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bingyan J. Wang
- Cardiovascular Regenerative Medicine (B.J.W., H.W.C.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Srinivas R. Dukkipati
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hina W. Chaudhry
- Cardiovascular Regenerative Medicine (B.J.W., H.W.C.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Carlos G Santos-Gallego
- Atherothrombosis Research Unit, Department of Cardiology (C.G.S.-G.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacob S. Koruth
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.), Icahn School of Medicine at Mount Sinai, New York, NY
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Huber TC, Bochnakova T, Koethe Y, Park B, Farsad K. Percutaneous Therapies for Hepatocellular Carcinoma: Evolution of Liver Directed Therapies. J Hepatocell Carcinoma 2021; 8:1181-1193. [PMID: 34589446 PMCID: PMC8476177 DOI: 10.2147/jhc.s268300] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022] Open
Abstract
Percutaneous ablation is a mainstay of treatment for early stage, unresectable hepatocellular carcinoma (HCC). Recent advances in technology have created multiple ablative modalities for treatment of this common malignancy. The purpose of this review is to familiarize readers with the technical and clinical aspects of both existing and emerging percutaneous treatment options for HCC.
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Affiliation(s)
- Timothy C Huber
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Teodora Bochnakova
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Yilun Koethe
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Brian Park
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Khashayar Farsad
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
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Galmén K, Jakobsson JG, Freedman J, Harbut P. Post-operative hypertension during early recovery following liver tumour ablation: A retrospective study. Acta Anaesthesiol Scand 2021; 65:1248-1253. [PMID: 34028010 DOI: 10.1111/aas.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND High-frequency jet ventilation is necessary to reduce organ movements during stereotactic liver ablation. However, post-operative hypertensive episodes especially following irreversible electroporation ablation compared with microwave ablation initiated this study. The hypothesis was that hypertensive episodes could be related to ventilation or ablation method. METHODS The aim of this retrospective study was to assess the proportion of patients with hypertensive events during recovery following liver ablation under general anaesthesia and to analyse the relation to ventilation and ablation technique. A medical chart review of 134 patients undergoing either high-frequency jet ventilation and microwave ablation (n = 45), high-frequency jet ventilation and irreversible electroporation (n = 44), or conventional ventilation and microwave ablation (n = 45) was performed. The proportion of patients with at least one episode of systolic arterial pressure 140-160, 160-180 or >180 mmHg during early recovery and the impact of ventilation method was studied. RESULTS Out of 134 patients, 100, 75 and 34 patients had at least one episode of mild, moderate and severe hypertension. Microwave ablation, as well as high frequency jet ventilation, was associated with an increased odds ratio for post-operative hypertension. The proportion of patients with at least one severe hypertensive event was 18/45, 9/44 and 7/45, respectively. CONCLUSION Both ventilation and ablation technique had an impact on post-operative hypertensive episodes. The microwave ablation/high-frequency jet ventilation combination increased the risk as compared with irreversible electroporation/high-frequency jet ventilation and microwave ablation/conventional ventilation.
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Affiliation(s)
- Karolina Galmén
- All at the Institution for Clinical Sciences Karolinska InstituteDanderyd University Hospital Stockholm Sweden
| | - Jan G. Jakobsson
- All at the Institution for Clinical Sciences Karolinska InstituteDanderyd University Hospital Stockholm Sweden
| | - Jacob Freedman
- All at the Institution for Clinical Sciences Karolinska InstituteDanderyd University Hospital Stockholm Sweden
| | - Piotr Harbut
- All at the Institution for Clinical Sciences Karolinska InstituteDanderyd University Hospital Stockholm Sweden
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McBride S, Avazzadeh S, Wheatley AM, O’Brien B, Coffey K, Elahi A, O’Halloran M, Quinlan LR. Ablation Modalities for Therapeutic Intervention in Arrhythmia-Related Cardiovascular Disease: Focus on Electroporation. J Clin Med 2021; 10:jcm10122657. [PMID: 34208708 PMCID: PMC8235263 DOI: 10.3390/jcm10122657] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 02/06/2023] Open
Abstract
Targeted cellular ablation is being increasingly used in the treatment of arrhythmias and structural heart disease. Catheter-based ablation for atrial fibrillation (AF) is considered a safe and effective approach for patients who are medication refractory. Electroporation (EPo) employs electrical energy to disrupt cell membranes which has a minimally thermal effect. The nanopores that arise from EPo can be temporary or permanent. Reversible electroporation is transitory in nature and cell viability is maintained, whereas irreversible electroporation causes permanent pore formation, leading to loss of cellular homeostasis and cell death. Several studies report that EPo displays a degree of specificity in terms of the lethal threshold required to induce cell death in different tissues. However, significantly more research is required to scope the profile of EPo thresholds for specific cell types within complex tissues. Irreversible electroporation (IRE) as an ablative approach appears to overcome the significant negative effects associated with thermal based techniques, particularly collateral damage to surrounding structures. With further fine-tuning of parameters and longer and larger clinical trials, EPo may lead the way of adapting a safer and efficient ablation modality for the treatment of persistent AF.
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Affiliation(s)
- Shauna McBride
- Physiology and Cellular Physiology Laboratory, CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, Human Biology Building, National University of Ireland (NUI) Galway, H91 W5P7 Galway, Ireland; (S.M.); (S.A.); (A.M.W.)
| | - Sahar Avazzadeh
- Physiology and Cellular Physiology Laboratory, CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, Human Biology Building, National University of Ireland (NUI) Galway, H91 W5P7 Galway, Ireland; (S.M.); (S.A.); (A.M.W.)
| | - Antony M. Wheatley
- Physiology and Cellular Physiology Laboratory, CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, Human Biology Building, National University of Ireland (NUI) Galway, H91 W5P7 Galway, Ireland; (S.M.); (S.A.); (A.M.W.)
| | - Barry O’Brien
- AtriAN Medical Limited, Unit 204, NUIG Business Innovation Centre, Upper Newcastle, H91 R6W6 Galway, Ireland; (B.O.); (K.C.)
| | - Ken Coffey
- AtriAN Medical Limited, Unit 204, NUIG Business Innovation Centre, Upper Newcastle, H91 R6W6 Galway, Ireland; (B.O.); (K.C.)
| | - Adnan Elahi
- Translational Medical Device Lab (TMDL), Lamb Translational Research Facility, University College Hospital Galway, H91 V4AY Galway, Ireland; (A.E.); (M.O.)
- Electrical & Electronic Engineering, School of Engineering, National University of Ireland Galway, H91 HX31 Galway, Ireland
| | - Martin O’Halloran
- Translational Medical Device Lab (TMDL), Lamb Translational Research Facility, University College Hospital Galway, H91 V4AY Galway, Ireland; (A.E.); (M.O.)
| | - Leo R. Quinlan
- Physiology and Cellular Physiology Laboratory, CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, Human Biology Building, National University of Ireland (NUI) Galway, H91 W5P7 Galway, Ireland; (S.M.); (S.A.); (A.M.W.)
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, H92 W2TY Galway, Ireland
- Correspondence:
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Modern therapeutic approaches for the treatment of malignant liver tumours. Nat Rev Gastroenterol Hepatol 2020; 17:755-772. [PMID: 32681074 DOI: 10.1038/s41575-020-0314-8] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 02/06/2023]
Abstract
Malignant liver tumours include a wide range of primary and secondary tumours. Although surgery remains the mainstay of curative treatment, modern therapies integrate a variety of neoadjuvant and adjuvant strategies and have achieved dramatic improvements in survival. Extensive tumour loads, which have traditionally been considered unresectable, are now amenable to curative treatment through systemic conversion chemotherapies followed by a variety of interventions such as augmentation of the healthy liver through portal vein occlusion, staged surgeries or ablation modalities. Liver transplantation is established in selected patients with hepatocellular carcinoma but is now emerging as a promising option in many other types of tumour such as perihilar cholangiocarcinomas, neuroendocrine or colorectal liver metastases. In this Review, we summarize the available therapies for the treatment of malignant liver tumours, with an emphasis on surgical and ablative approaches and how they align with other therapies such as modern anticancer drugs or radiotherapy. In addition, we describe three complex case studies of patients with malignant liver tumours. Finally, we discuss the outlook for future treatment, including personalized approaches based on molecular tumour subtyping, response to targeted drugs, novel biomarkers and precision surgery adapted to the specific tumour.
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Belfiore MP, Reginelli A, Maggialetti N, Carbone M, Giovine S, Laporta A, Urraro F, Nardone V, Grassi R, Cappabianca S, Brunese L. Preliminary results in unresectable cholangiocarcinoma treated by CT percutaneous irreversible electroporation: feasibility, safety and efficacy. Med Oncol 2020; 37:45. [PMID: 32270353 DOI: 10.1007/s12032-020-01360-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/10/2020] [Indexed: 12/12/2022]
Abstract
Cholangiocarcinoma (CC) accounts for about 3% of the gastrointestinal and 10-25% of all hepatobiliary malignancies. It arises from the epithelium of the bile duct and it can be classified in intrahaepatic (ICC), perihilar (PCC) and distal (DCC) cholangiocarcinoma, depending on the anatomical location. About 50-60% of the cases are PCC. Early detection is very difficult for the lack of symptoms, and most of the patients are not resectable at the time of diagnosis. IRE is a non-thermal ablation technique that determines cellular apoptosis by electrical impulses without involving extracellular matrix like MW or RF ablation (MWA and RFA). The aim of our study is to demonstrate the safety, feasibility and efficacy of this procedure in the treatment of cholangiocarcinoma according to our experience. From 2015 to 2019, fifteen patients with unre-sectable perhilar and intrahepatic colangiocarcinoma (7 female and 8 male, mean age 69.2) were referred to our department to be enrolled in our prospective study that was approved by local Ethical Committee. Eight lesions were defined iCC and seven of them pCC. Six patients had biliary STENT and four external percutaneous transhepatic biliary drainage (PTBD). The IRE procedure was performed to expert radiologist (G.B.) under CT guidance using the Nanoknife IRE device (Angiodynamics, Queensbury, NY). The data before and after treatment were compared using Wilcoxon Rank Test and the survival outcome was evaluated using Kaplan Meyer Test. All procedures performed under CT guidance have been successfully completed. Treated lesions were located seven perhilar and eight intrahepatic sites and showed a mean volume 66.3 (SD 70.9; IC ranged from 5.57 to 267.20 cm3). No major complications were observed. From 30 to 90 days, the mortality rate was around 0%. Progression of the disease in all cases were not observed. Only one patient was reported increase of the Ca19-9 without sign of pancreatitis and bile obstruction. The imaging follow-up showed the local disease control with a decrease of the entire volume of the lesion and a further reduction of the densitometric values. From the comparison between the mean volumes for each group (before and after treatment), the Wilcoxon Rank test demonstrated the statistical significant difference with a p value < 0.01. On the contrary, it is believed that this results encouraging in considering the IRE procedure the safe, feasible and effective method in the treatment of the CC.
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Affiliation(s)
- Maria Paola Belfiore
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138, Naples, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138, Naples, Italy.
| | - Nicola Maggialetti
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via Francesco De Sanctis 1, Campobasso, Italy
| | - Mattia Carbone
- Department of Radiology, San Giovanni E Ruggi D'Aragona Hospital, Ospedale, Via San Leonardo, Salerno, Italy
| | - Sabrina Giovine
- Department of Radiology, SG Moscati Hospital, ASL Caserta, Aversa, Italy
| | | | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138, Naples, Italy
| | - Valerio Nardone
- Unit of Radiation Oncology, Ospedale del Mare, 80147, Naples, Italy
| | - Roberta Grassi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138, Naples, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138, Naples, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via Francesco De Sanctis 1, Campobasso, Italy
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Fang G, Niu L, Chen J. Prevention of Procedural Hypertension in the Irreversible Electroporation Ablation of Liver and Pancreatic Tumors Based on Distance from the Adrenal Gland. Cancer Manag Res 2020; 12:71-78. [PMID: 32021424 PMCID: PMC6954856 DOI: 10.2147/cmar.s235227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/12/2019] [Indexed: 01/04/2023] Open
Abstract
Background and objective When irreversible electroporation (IRE) ablation of abdominal tumors, procedural hypertension often occurs, which often affects the progress of the ablation. Until now, there is no reasonable explanation for this phenomenon. The objective of this research was to explore the cause and solution of procedural hypertension in percutaneous IRE. Methods In this study, the treatment data of 4 consecutive groups of patients were used to confirm the cause of intraoperative hypertension and then verify the solution. A total of 155 patients with procedural hypertension were screened based on their medical records of pancreatic or hepatic IRE treatment. Procedural hypertension was monitored in 21 new patients, the correlation between serum catecholamines and hypertension was recorded and evaluated using regression analysis. Forty new patients were divided into two groups (distance from needle tip to adrenal gland, < 2 cm vs ≥ 2 cm), and the blood pressure was recorded and compared with two-way ANOVA. Eleven patients with ablative distance <2 cm were treated in advance with phentolamine to observe for the occurrence of procedural hypertension. Results Of the 21 re-enrolled patients with ablation of the pancreas and liver tumors, 9 developed intraoperative hypertension with significantly elevated serum catecholamines levels, epinephrine, norepinephrine and dopamine are all positively associated with hypertension, with P values were 0.0003, 0.0253, and 0.0015, respectively. For the two groups with different needle-insertion distances, hypertension in the < 2 cm group was more significant than that in the other group (for procedural hypertension, P< 0.01; for heart rate, P< 0.05), which was considered as a high-risk group. The occurrence of intraoperative hypertension could be completely prevented by using phentolamine prior to treatment. Conclusion Hypertension occurs frequently during hepatic and pancreatic IRE because of the damage of adrenal gland. The safe distance of ablation probe for the adrenal gland was 2 cm. For high-risk patients, early drug prevention works well.
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Affiliation(s)
- Gang Fang
- Fuda Cancer Hospital of Jinan University, Guangzhou 510665, People's Republic of China
| | - Lizhi Niu
- Fuda Cancer Hospital of Jinan University, Guangzhou 510665, People's Republic of China
| | - Jibing Chen
- Fuda Cancer Hospital of Jinan University, Guangzhou 510665, People's Republic of China
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9
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Jiang T, Zhao Q, Tian G, Chen X, Wu L. Irreversible electroporation ablation of end-stage metastatic retroperitoneal lesions: Report on three cases and literature review. Exp Ther Med 2019; 18:2243-2249. [PMID: 31410175 DOI: 10.3892/etm.2019.7780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 04/26/2019] [Indexed: 12/16/2022] Open
Abstract
Metastatic retroperitoneal tumors constitute an end-stage disease with poor prognosis that represents a heavy global health burden. The present study aimed to explore the efficacy of irreversible electroporation ablation (IRE) therapy in patients with end-stage retroperitoneal tumors. Between April 2016 and September 2017, three patients with unresectable retroperitoneal malignant tumors were enrolled. Among these cases, ultrasound (US)-guided IRE was palliatively performed for targeting 3 tumors (1 tumor per patient) located around the abdominal aorta. Post-treatment contrast-enhanced US (CEUS) and contrast-enhanced computed tomography (CECT) scans were subsequently performed to evaluate the area adjacent to the ablation zone and determine the prognosis. During the follow-up, the cases experienced a reduction of pain (mean score of 5.8 decreased to 2.2, based on the visual analogue scale), and had an overall survival rate ranging from 2 to 11 months. Case 1 remained alive at the time of submission of this study, but case 2 died within 2 months and case 3 within 11 months due to liver metastases of the primary tumor. At the 3-week follow-up, the CEUS image for case 1 exhibited a contrast defect with a sufficient ablation margin, in accordance with the CECT at 1.5 months following IRE, exhibiting complete tumor necrosis without contrast enhancement. Overall, these results suggest that US-guided percutaneous IRE may be effective in the treatment of end-stage retroperitoneal tumors. However, further studies are required to substantiate the conclusions of the present study. The present clinical trial was registered at clinicaltrials.gov (ID: NCT02822066) on June 20th, 2016.
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Affiliation(s)
- Tian'An Jiang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Qiyu Zhao
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Guo Tian
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Xinhua Chen
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
| | - Liming Wu
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, P.R. China
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10
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Hoffer EK, Shelton TW, Ring NY. Pulmonary Hemorrhage during Irreversible Electroporation of Hepatocellular Carcinoma. J Vasc Interv Radiol 2019; 30:970-972.e1. [PMID: 31126611 DOI: 10.1016/j.jvir.2019.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/08/2019] [Accepted: 02/17/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Eric K Hoffer
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03755; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | | | - Natalie Y Ring
- Department of Radiology, Johns Hopkins Medical Center, Baltimore, Maryland
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11
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Mafeld S, Wong JJ, Kibriya N, Stenberg B, Manas D, Bassett P, Aslam T, Evans J, Littler P. Percutaneous Irreversible Electroporation (IRE) of Hepatic Malignancy: A Bi-institutional Analysis of Safety and Outcomes. Cardiovasc Intervent Radiol 2018; 42:577-583. [PMID: 30465255 PMCID: PMC6394503 DOI: 10.1007/s00270-018-2120-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023]
Abstract
Aim Irreversible electroporation (IRE) is a non-thermal ablative option in patients unsuitable for standard thermal ablation, due to its potential to preserve collagenous structures (vessels and ducts) and a reduced susceptibility to heat sink effects. In this series from two large tertiary referral hepatobiliary centres, we aim to assess the safety/outcomes of hepatic IRE. Materials and Methods Bi-institutional retrospective, longitudinal follow-up series of IRE for primary hepatic malignancy; [hepatocellular carcinoma (n = 20), cholangiocarcinoma (n = 3)] and secondary metastatic disease; colorectal (n = 28), neuroendocrine (n = 1), pancreatic (n = 1), breast (n = 1), gastrointestinal stromal tumour (GIST, n = 1) and malignant thymoma (n = 1). Outcome measures included procedural safety/effectiveness, time to progression and time to death. Results Between 2013 and 2017, 52 patients underwent percutaneous IRE of 59 liver tumours in 53 sessions. All tumours were deemed unsuitable for thermal ablation. Cases were performed using ultrasound (US) or computed tomography (CT) guidance. A complete ablation was achieved in n = 44, (75%) of cases with an overall complication rate of 17% (n = 9). Of the complete ablation group, median time to progression was 8 months. At 12 months, 44% were progression-free (95% CI 30–66%). The data suggest that larger lesion size (> 2 cm) is associated with shorter time to progression and there is highly significant difference with faster time to progression in mCRC compared with HCC. Median survival time was 38 months. Conclusion This bi-institutional review is the largest UK series of IRE and suggests this ablative technology can be a useful tool, but appears to mainly induce local tumour control rather than cure with HCC having better outcomes than mCRC.
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Affiliation(s)
- Sebastian Mafeld
- Department of Interventional Radiology, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK.
| | - Jen Jou Wong
- Department of Interventional Radiology, Royal Liverpool University Hospital, Prescot St, Liverpool, L7 8XP, UK
| | - Nabil Kibriya
- Department of Interventional Radiology, Royal Liverpool University Hospital, Prescot St, Liverpool, L7 8XP, UK
| | - Ben Stenberg
- Department of Interventional Radiology, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - Derek Manas
- Department of Hepatobiliary Surgery, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | | | - Tahira Aslam
- Department of Interventional Radiology, Royal Liverpool University Hospital, Prescot St, Liverpool, L7 8XP, UK
| | - Jonathan Evans
- Department of Interventional Radiology, Royal Liverpool University Hospital, Prescot St, Liverpool, L7 8XP, UK
| | - Peter Littler
- Department of Interventional Radiology, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
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Kostrzewa M, Tueluemen E, Rudic B, Rathmann N, Akin I, Henzler T, Liebe V, Schoenberg SO, Borggrefe M, Diehl SJ. Cardiac impact of R-wave triggered irreversible electroporation therapy. Heart Rhythm 2018; 15:1872-1879. [PMID: 30017817 DOI: 10.1016/j.hrthm.2018.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Irreversible electroporation (IRE) is a novel tumor ablative therapy technique, using electric fields to induce apoptosis in target tissues. Whether these electric pulses of high field strength can cause cardiac damage and/or ablation-induced arrhythmias is unclear. OBJECTIVE The purpose of this study was to systematically evaluate the safety of electrocardiogram (ECG)-gated IRE with regard to cardiac side effects. METHODS In all patients, 12-lead ECG and signal-averaged ECG (SAECG) recordings were performed before and after IRE and 24-hour Holter recording on the day of the IRE procedure. Venous blood samples (N-terminal pro-brain-type natriuretic peptide [NT-proBNP], high-sensitive troponin I [hsTnI]) were obtained before and 4 and 16 hours after the procedure. Patients with abnormal findings were reevaluated after 3 months. RESULTS In total, 26 patients with an oncologic indication for IRE (11 females, mean age 62.9 years) were prospectively enrolled. Nine patients (34.6%) showed an increase in hsTnI and 21 patients (80.8%) an increase in NT-proBNP after ablation. Fifteen patients (57%) developed arrhythmias related to the procedure. One patient, in whom hsTnI and NT-proBNP had increased, developed multiple, nonsustained ventricular tachycardia events. In another patient, atrial fibrillation was triggered twice in 2 separate procedures. Twelve patients had clinically benign arrhythmias. SAECG was negative in all patients. CONCLUSION Subclinical myocardial injury and nonfatal cardiac arrhythmias can occur in the context of IRE treatment. Although no sustained cardiac injuries could be found at 3-month follow-up, we propose implementation of a cardiac safety algorithm consisting of cardiac biomarkers and ECG monitoring when IRE is conducted.
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Affiliation(s)
- Michael Kostrzewa
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Erol Tueluemen
- DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Boris Rudic
- DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nils Rathmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ibrahim Akin
- DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Volker Liebe
- DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Borggrefe
- DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Steffen J Diehl
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Sánchez-Velázquez P, Clavien PA. The role of the irreversible electroporation in the hepato-pancreatico-biliary surgery. Cir Esp 2017; 95:307-312. [PMID: 28318494 DOI: 10.1016/j.ciresp.2017.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 01/26/2017] [Indexed: 12/19/2022]
Abstract
Irreversible electroporation is a novel technique growing in popularity over the last years among the ablative modalities. Its unique action mechanism produces irreversible nanopores in the membrane of the cell leading to apoptosis; therefore irreversible electroporation can be used to ablate substantial volumes of tissue without the undesirable thermal effects as the "heat sink effect". Moreover the extracellular matrix is left unperturbed, thus sparing the structural architecture of surrounding structures such as bile ducts and blood vessels. In the last years its use has been widespread in both liver and pancreatic ablation. Irreversible electroporation has shown its safety with however some caution, feasibility and favorable outcomes in clinical settings such as unresectable locally advanced disease in which the surgical and therapeutic options are very limited.
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Affiliation(s)
| | - Pierre-Alain Clavien
- Departmento de cirugía y transplante, Hospital universitario de Zürich, Zúrich, Suiza.
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