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Zhang K, Stricker P, Löhr M, Stehling M, Suberville M, Cussenot O, Lunelli L, Ng CF, Teoh J, Laguna P, de la Rosette J. A multi-center international study to evaluate the safety, functional and oncological outcomes of irreversible electroporation for the ablation of prostate cancer. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-023-00783-y. [PMID: 38195916 DOI: 10.1038/s41391-023-00783-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/08/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Irreversible electroporation (IRE) is a novel technique to treat localized prostate cancer with the aim of achieving oncological control while reducing related side effects. We present the outcomes of localized prostate cancer treated with IRE from a multi-center prospective registry. METHODS Men with histologically confirmed prostate cancer were recruited to receive IRE. All the patients were proposed for prostate biopsy at 1-year post-IRE ablation. The functional outcomes were measured by the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) questionnaires. The safety of IRE was graded by the treatment-related adverse events (AEs) according to the Common Terminology Criteria for Adverse Events (CTCAE). RESULTS 411 patients were recruited in this study from July 2015 to April 2020. The median follow-up time was 24 months (IQR 15-36). 116 patients underwent repeat prostate biopsy during 12-18 months after IRE. Clinically significant prostate cancer (Gleason ≥ 3 + 4) was detected in 24.1% (28/116) of the patients; any grade prostate cancers were found in 59.5% (69/116) of the patients. The IPSS score increased significantly from 7.1 to 8.2 (p = 0.015) at 3 months but decreased to 6.1 at 6 months (p = 0.017). Afterwards, the IPSS level remained stable during follow-up. The IIEF-5 score decreased at 3 months from 16.0 to 12.1 (p < 0.001) and then maintained equable afterwards. The rate of AEs was 1.8% at 3 months and then dropped to less than 1% at 6 months and remained stable until 48 months after IRE. Major AEs (Grade 3 or above) were rare. CONCLUSION For men with localized prostate cancer, IRE could achieve good urinary and sexual function outcomes and a reasonable oncological result. The real-world data are consistent with earlier studies, including recently published randomized controlled studies. The long-term oncological results need further investigation and follow-up.
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Affiliation(s)
- Kai Zhang
- Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China
| | - Phillip Stricker
- Department of Urology, St Vincents Private Hospital Sydney, St Vincents Prostate Cancer Research Centre and The Garvan Institute, Sydney, Australia
| | - Martin Löhr
- Department of Urology, Klinik für Prostata-Therapie, Heidelberg, Germany
| | - Michael Stehling
- VITUS Privatklinik and Institut für Bildgebende Diagnostik, Strahlenbergerstrasse, Offenbach, Germany
| | - Michel Suberville
- Doctor Michel SUBERVILLE Chief of Pôle, Pôle SAINT GERMAIN - CENTRE HOSPITALIER, Brive la Gaillarde, France
| | | | - Luca Lunelli
- Department of Urology, Hospital Louis Pasteur, Chartres, France
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Jeremy Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Pilar Laguna
- Department of Urology, Medipol Mega hospital, Istanbul Medipol University, Istanbul, Türkiye
| | - Jean de la Rosette
- Department of Urology, Medipol Mega hospital, Istanbul Medipol University, Istanbul, Türkiye.
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Beitel-White N, Lorenzo MF, Zhao Y, Brock RM, Coutermarsh-Ott S, Allen IC, Manuchehrabadi N, Davalos RV. Multi-Tissue Analysis on the Impact of Electroporation on Electrical and Thermal Properties. IEEE Trans Biomed Eng 2021; 68:771-782. [PMID: 32746081 PMCID: PMC8048145 DOI: 10.1109/tbme.2020.3013572] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Tissue electroporation is achieved by applying a series of electric pulses to destabilize cell membranes within the target tissue. The treatment volume is dictated by the electric field distribution, which depends on the pulse parameters and tissue type and can be readily predicted using numerical methods. These models require the relevant tissue properties to be known beforehand. This study aims to quantify electrical and thermal properties for three different tissue types relevant to current clinical electroporation. METHODS Pancreatic, brain, and liver tissue were harvested from pigs, then treated with IRE pulses in a parallel-plate configuration. Resulting current and temperature readings were used to calculate the conductivity and its temperature dependence for each tissue type. Finally, a computational model was constructed to examine the impact of differences between tissue types. RESULTS Baseline conductivity values (mean 0.11, 0.14, and 0.12 S/m) and temperature coefficients of conductivity (mean 2.0, 2.3, and 1.2 % per degree Celsius) were calculated for pancreas, brain, and liver, respectively. The accompanying computational models suggest field distribution and thermal damage volumes are dependent on tissue type. CONCLUSION The three tissue types show similar electrical and thermal responses to IRE, though brain tissue exhibits the greatest differences. The results also show that tissue type plays a role in the expected ablation and thermal damage volumes. SIGNIFICANCE The conductivity and its changes due to heating are expected to have a marked impact on the ablation volume. Incorporating these tissue properties aids in the prediction and optimization of electroporation-based therapies.
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Sorokin I, Canvasser N, Johnson B, Lucas E, Cadeddu JA. Irreversible Electroporation for Renal Ablation Does Not Cause Significant Injury to Adjacent Ureter or Bowel in a Porcine Model. J Endourol 2020; 35:873-877. [PMID: 33198480 DOI: 10.1089/end.2020.0856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: To evaluate the safety of irreversible electroporation (IRE) for renal ablation adjacent to the ureter or bowel. Materials and Methods: Six adult pigs each underwent bilateral IRE of the kidney. To simulate adjacence, the left proximal ureter and duodenum were secured onto the left and right kidney capsule, respectively. Two IRE probes were placed into the renal parenchyma and configured to bridge the ureter and bowel. Therapeutic IRE was delivered at 2000 V/cm for 70 pulses in both forward and reverse polarity. The animal was survived and euthanized at 1, 3, or 14 days. Histopathology was obtained for all potentially injured bowel and ureteral segments. Retrograde pyelogram (RPG) was performed on each left-sided ureter. Results: Histologic analysis of the ureter identified reactive changes at the level of the periureteral adipose tissue, which progressed from acute inflammation on day 1 to focal fibrosis by day 14. Urothelial mucosa and surrounding smooth muscle layers were unaffected at all time points. RPGs did not show any abnormalities in all specimens. Histologic analysis of the bowel demonstrated acute inflammation in the serosa and subserosal tissue on day 1. Three days after IRE, inflammation and crypt abscesses were focally present in the deep aspects of the bowel mucosa. Inflammation in the mucosal layer resolved 14 days after IRE. Conclusions: In a porcine model of renal IRE, no significant injury was apparent after intentional ablation adjacent to the ureter and bowel. IRE may be a safe alternative to thermal ablation for tumors near the ureter or bowel.
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Affiliation(s)
- Igor Sorokin
- Department of Urology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Noah Canvasser
- Department of Urology, UC Davis Medical Center, Sacramento, California, USA
| | - Brett Johnson
- Department of Urology and UT Southwestern Medical Center, Dallas, Texas, USA
| | - Elena Lucas
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jeffrey A Cadeddu
- Department of Urology and UT Southwestern Medical Center, Dallas, Texas, USA
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Tamura M, Pedersoli F, Schulze-Hagen M, Zimmerman M, Isfort P, Kuhl CK, Schmitz-Rode T, Bruners P. Predictors of Occlusion of Hepatic Blood Vessels after Irreversible Electroporation of Liver Tumors. J Vasc Interv Radiol 2020; 31:2033-2042.e1. [PMID: 33267950 DOI: 10.1016/j.jvir.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To examine predictors of midterm occlusion in portal and hepatic veins within or adjacent to the ablation zone after irreversible electroporation (IRE) of liver tumors. MATERIALS AND METHODS This retrospective cohort analysis included 39 patients who underwent CT-guided IRE of liver tumors. Vessels within or adjacent to the ablation zone were identified on CT images acquired immediately after the procedure, and the positional relationships with the ablation zone (within/adjacent), locations (proximal/distal), and diameters (< 4 mm or ≥ 4 mm) were evaluated. Using contrast-enhanced follow-up scans, each vessel was classified as patent, stenosed, or occluded. Associations between vessel occlusion and each variable were investigated. RESULTS Overall, 33 portal veins and 64 hepatic veins were analyzed. Follow-up scans showed occlusion in 12/33 (36.7%) portal veins and 17/64 (26.6%) hepatic veins. Vessels within the ablation zone were occluded significantly more frequently than vessels adjacent to the ablation zone (portal: 55.6% [10/18] vs 13.3% [2/15], P = .04; hepatic: 45.4% [15/33] vs 6.4% [2/31], P = .011). Vessels with a diameter < 4 mm were also occluded significantly more frequently than vessels with a diameter ≥ 4 mm (portal: 72.7% [8/11] vs 18.1% [4/22], P = .011; hepatic: 54.8% [17/31] vs 0% [0/33], P < .001). The respective positive and negative predictive values for occlusion of vessels categorized as both within and < 4 mm were 88% (7/8) and 82% (20/25) for portal veins and 79% (15/19) and 96% (43/45) for hepatic veins. CONCLUSIONS Midterm vessel occlusion after liver IRE could be predicted with relatively high accuracy by assessing ablation location and vessel diameter.
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Affiliation(s)
- Masashi Tamura
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany; Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany; Department of Radiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Maximilian Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Markus Zimmerman
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Thomas Schmitz-Rode
- Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
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Untanas A, Trakymas M, Lekienė I, Briedienė R. Von Hippel-Lindau syndrome and renal tumours: radiological diagnostic and treatment options. A case report and literature review. Acta Med Litu 2020; 27:25-32. [PMID: 32577093 DOI: 10.6001/actamedica.v27i1.4263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Von Hippel-Lindau disease (VHL) is a rare autosomal dominant syndrome diagnosed for 1 out of 36000-45000 newborns and 90% of the patients have a clinical manifestation before 65 years of age. Affected individuals have an increased risk of developing tumours in several organs or their systems. The most common tumours are retinal or central nervous system hemangioblastomas (60-80%) and VHL-associated renal lesions. Contrast-enhanced computer tomography (CECT) is the gold standard for the diagnosis and characterization of renal tumours. The best treatment option for VHL syndrome-caused renal tumours are nephron-sparing treatment techniques (cryotherapy, radiofrequency, or microwave ablation), which require imaging control. All these innovative treatment techniques are extremely important for VHL patients, because they increase the quality of life by staving off renal dialysis and preventing distant metastases. Case report Our case report presents a 16-year-old female with multiple renal cysts observed on ultrasound examination and clinically and molecularly diagnosed with Von Hippel-Lindau syndrome (deletion of the entire VHL gene). After that, for past 11 years multiple renal tumours were removed by cryoablation and patient monitoring on contrast-enhanced magnetic resonance (MRI) and CECT control scans was conducted. Conclusions Active multidisciplinary patient follow-up, routine radiological examinations, and correct treatment tactics allow controlling the progression of renal cell carcinoma and other tumours associated with VHL syndrome, maintaining a normal organ function for a long time, and preventing distant metastases and fatal disease outcomes.
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Affiliation(s)
- Audrius Untanas
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Indrė Lekienė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rūta Briedienė
- National Cancer Institute, Vilnius, Lithuania.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Frey GT, Padula CA, Stauffer JA, Toskich BB. Intraoperative Irreversible Electroporation in Locally Advanced Pancreatic Cancer: A Guide for the Interventional Radiologist. Semin Intervent Radiol 2019; 36:386-391. [PMID: 31798212 DOI: 10.1055/s-0039-1697640] [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] [Indexed: 02/07/2023]
Abstract
Efforts to improve mortality associated with locally advanced pancreatic cancer (LAPC) have shown minimal gains despite advances in surgical technique, systemic treatments, and radiation therapy. Locoregional therapy with ablation has not been routinely adopted due to the high risk of complications associated with thermal destruction of the pancreas. Irreversible electroporation (IRE) is an emerging, nonthermal, ablative technology that has demonstrated the ability to generate controlled ablation of LAPC while preserving pancreatic parenchymal integrity. IRE may be performed percutaneously or via laparotomy and will commonly involve multidisciplinary treatment teams. This article will describe the technical aspects of how multidisciplinary IRE is performed during laparotomy at a single tertiary care institution.
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Affiliation(s)
- Gregory T Frey
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Carlos A Padula
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | | | - Beau B Toskich
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
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9
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Canvasser NE, Lay AH, Koseoglu E, Kavoussi N, Sorokin I, Gahan J, Lucas E, Cadeddu JA. Effect of Differing Parameters on Irreversible Electroporation in a Porcine Model. J Endourol 2018; 32:338-343. [DOI: 10.1089/end.2017.0495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Noah E. Canvasser
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aaron H. Lay
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ersin Koseoglu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nicholas Kavoussi
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Igor Sorokin
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey Gahan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elena Lucas
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey A. Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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10
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Rashid MF, Hecht EM, Steinman JA, Kluger MD. Irreversible electroporation of pancreatic adenocarcinoma: a primer for the radiologist. Abdom Radiol (NY) 2018; 43:457-466. [PMID: 29051982 DOI: 10.1007/s00261-017-1349-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Irreversible electroporation (IRE) is increasingly used for the ablation of unresectable locally advanced pancreatic adenocarcinoma. Unlike other ablation technologies that cannot be safely used around critical vasculature or ducts for risk of thermal damage, IRE uses high-voltage pulses to disrupt cellular membranes. This causes cell death by apoptosis and inflammation. IRE has been deployed by both open and percutaneous approaches. Generator parameters are the same for both approaches, and settings are pancreas specific. Variations in settings, probe placement, and probe exposure can result in thermal damage or reversible electroporation and resultant treatment failure, morbidity, or mortality. When used properly, IRE appears to improve overall survival and local recurrence, but does not influence the rate of distant recurrence. However, studies of both open and percutaneous approaches have been relatively small, non-controlled, and without appropriate comparisons. It is challenging for the radiologist to interpret treatment effects after IRE because of a dearth of guiding literature and pathologic correlates. This primer describes technical aspects, pathology correlates, post-IRE imaging, and outcomes for percutaneous and open approaches.
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Affiliation(s)
- M Farzan Rashid
- Division of Gastrointestinal and Endocrine Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave - 8th Floor, New York, NY, USA
| | - Elizabeth M Hecht
- Division of Abdominal Imaging, Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Jonathan A Steinman
- Division of Abdominal Imaging, Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Michael D Kluger
- Division of Gastrointestinal and Endocrine Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave - 8th Floor, New York, NY, USA.
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Dong S, Wang H, Zhao Y, Sun Y, Yao C. First Human Trial of High-Frequency Irreversible Electroporation Therapy for Prostate Cancer. Technol Cancer Res Treat 2018; 17:1533033818789692. [PMID: 30045668 PMCID: PMC6071159 DOI: 10.1177/1533033818789692] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/10/2018] [Accepted: 06/21/2018] [Indexed: 12/16/2022] Open
Abstract
Irreversible electroporation, as a nonthermal therapy of prostate cancer, has been used in clinic for several years. The mechanism of irreversible electroporation ablation is thermal independent; thus, the main structures (eg, rectum, urethra, and neurovascular bundle) in prostate are spared during the treatment, which leads to the retention of prostate function. However, various clinical trials have shown that muscle contractions occur during this therapy, which warrants deep muscle anesthesia. Use of high-frequency bipolar pulses has been proposed to reduce muscle contractions during treatment, which has already triggered a multitude of studies at the cellular and animal scale. In this study, we first investigated the efficacy and safety of high-frequency bipolar pulses in human prostate cancer ablation. There are 40 male patients with prostate cancer aged between 51 and 85 years involved in this study. All patients received 250 high-frequency bipolar pulse bursts with the repeat frequency of 1 Hz. Each burst comprised 20 individual pulses of 5 microseconds, so one burst total energized time was 100 microseconds. The number of the electrodes ranged 2 to 6, depending on tumor size. A small amount of muscle relaxant was still needed, so there were no visible muscle contractions during the pulse delivery process. Four weeks after treatment, it was found that the ablation margins were distinct in magnetic resonance imaging scans, and the prostate capsule and urethra were retained. Eight patients underwent radical prostatectomy for pathological analysis after treatment, and the results of hematoxylin and eosin staining revealed that the urethra and major vasculature in prostate have been preserved. By overlaying the electric field contour on the ablation zone, the electric field lethality threshold is determined to be 522 ± 74 V/cm. This study is the first to validate the feasibility of tumor ablation by high-frequency bipolar pulses and provide valuable experience of irreversible electroporation in clinical applications.
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Affiliation(s)
- Shoulong Dong
- State Key Laboratory of Power Transmission Equipment & System Security
and New Technology, Chongqing University, Chongqing, People’s Republic of China
| | - Haifeng Wang
- Department of Urology, Shanghai Changhai Hospital, Shanghai, People’s
Republic of China
| | - Yajun Zhao
- State Key Laboratory of Power Transmission Equipment & System Security
and New Technology, Chongqing University, Chongqing, People’s Republic of China
| | - Yinghao Sun
- Department of Urology, Shanghai Changhai Hospital, Shanghai, People’s
Republic of China
| | - Chenguo Yao
- State Key Laboratory of Power Transmission Equipment & System Security
and New Technology, Chongqing University, Chongqing, People’s Republic of China
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Sorokin I, Lay AH, Reddy NK, Canvasser NE, Chamarthy M, Cadeddu JA. Pain After Percutaneous Irreversible Electroporation of Renal Tumors Is Not Dependent on Tumor Location. J Endourol 2017; 31:751-755. [DOI: 10.1089/end.2017.0201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Igor Sorokin
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aaron H. Lay
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Nikitha K. Reddy
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Noah E. Canvasser
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Murthy Chamarthy
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey A. Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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A Comprehensive Characterization of Parameters Affecting High-Frequency Irreversible Electroporation Lesions. Ann Biomed Eng 2017; 45:2524-2534. [DOI: 10.1007/s10439-017-1889-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/12/2017] [Indexed: 12/11/2022]
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Yao C, Dong S, Zhao Y, Lv Y, Liu H, Gong L, Ma J, Wang H, Sun Y. Bipolar Microsecond Pulses and Insulated Needle Electrodes for Reducing Muscle Contractions During Irreversible Electroporation. IEEE Trans Biomed Eng 2017; 64:2924-2937. [PMID: 28391185 DOI: 10.1109/tbme.2017.2690624] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To minimize the effect of muscle contractions during irreversible electroporation (IRE), this paper attempts to research the ablation effect and muscle contractions by applying high-frequency IRE (H-FIRE) ablation to liver tissue in vivo. METHODS An insulated needle electrode was produced by painting an insulating coating on the outer surface of the needle electrode tip. A series of experiments were conducted using insulated needle electrodes and traditional needle electrodes to apply H-FIRE pulses and traditional monopolar IRE pulses to rabbit liver tissues. The finite element model of the rabbit liver tissue was established to determine the lethal thresholds of H-FIRE in liver tissues. Muscle contractions were measured by an accelerometer. RESULTS With increased constitutive pulse width and pulse voltage, the ablation area and muscle contraction strength are also increased, which can be used to optimize the ablation parameters of H-FIRE. Under the same pulse parameters, the ablation areas are similar for the two types of electrodes, and the ablation region has a clear boundary. H-FIRE and insulated needle electrodes can mitigate the extent of muscle contractions. The lethal thresholds of H-FIRE in rabbit liver tissues were determined. CONCLUSION This paper describes the relationships between the ablation area, muscle contractions, and pulse parameters; the designed insulated needle electrodes can be used in IRE for reducing muscle contraction. SIGNIFICANCE The study provides guidance for treatment planning and reducing muscle contractions in the clinical application of H-FIRE.
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Irreversible electroporation of small renal masses: suboptimal oncologic efficacy in an early series. World J Urol 2017; 35:1549-1555. [DOI: 10.1007/s00345-017-2025-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 02/13/2017] [Indexed: 01/03/2023] Open
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Buijs M, van Lienden KP, Wagstaff PG, Scheltema MJ, de Bruin DM, Zondervan PJ, van Delden OM, van Leeuwen TG, de la Rosette JJ, Laguna MP. Irreversible Electroporation for the Ablation of Renal Cell Carcinoma: A Prospective, Human, In Vivo Study Protocol (IDEAL Phase 2b). JMIR Res Protoc 2017; 6:e21. [PMID: 28209559 PMCID: PMC5334515 DOI: 10.2196/resprot.6725] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/27/2016] [Accepted: 01/03/2017] [Indexed: 12/18/2022] Open
Abstract
Background Irreversible electroporation (IRE) is an emerging technique delivering electrical pulses to ablate tissue, with the theoretical advantage to overcome the main shortcomings of conventional thermal ablation. Recent short-term research showed that IRE for the ablation of renal masses is a safe and feasible treatment option. In an ablate and resect design, histopathological analysis 4 weeks after radical nephrectomy demonstrated that IRE-targeted renal tumors were completely covered by ablation zone. In order to develop a validated long-term IRE follow-up study, it is essential to obtain clinical confirmation of the efficacy of this novel technology. Additionally, follow-up after IRE ablation obliges verification of a suitable imaging modality. Objective The objectives of this study are the clinical efficacy and safety of IRE ablation of renal masses and to evaluate the use of cross-sectional imaging modalities in the follow-up after IRE in renal tumors. This study conforms to the recommendations of the IDEAL Collaboration and can be categorized as a phase 2B exploration trial. Methods In this prospective clinical trial, IRE will be performed in 20 patients aged 18 years and older presenting with a solid enhancing small renal mass (SRM) (≤4 cm) who are candidates for ablation. Magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) will be performed at 1 day pre-IRE, and 1 week post-IRE. Computed tomography (CT), CEUS, and MRI will be performed at 3 months, 6 months, and 12 months post-IRE. Results Presently, recruitment of patients has started and the first inclusions are completed. Preliminary results and outcomes are expected in 2018. Conclusions To establish the position of IRE ablation for treating renal tumors, a structured stepwise assessment in clinical practice is required. This study will offer fundamental knowledge on the clinical efficacy of IRE ablation for SRMs, potentially positioning IRE as ablative modality for renal tumors and accrediting future research with long-term follow-up. Trial Registration Clinicaltrials.gov registration number NCT02828709; https://clinicaltrials.gov/ct2/show/NCT02828709 (archived by WebCite at http://www.webcitation.org/6nmWK7Uu9). Dutch Central Committee on Research Involving Human Subjects NL56935.018.16
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Affiliation(s)
- Mara Buijs
- Academic Medical Center, Department of Urology, University of Amsterdam, Amsterdam, Netherlands
| | - Krijn P van Lienden
- Academic Medical Center, Department of Radiology, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Gk Wagstaff
- Academic Medical Center, Department of Urology, University of Amsterdam, Amsterdam, Netherlands
| | - Matthijs Jv Scheltema
- Academic Medical Center, Department of Urology, University of Amsterdam, Amsterdam, Netherlands
| | - Daniel M de Bruin
- Academic Medical Center, Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, Netherlands
| | - Patricia J Zondervan
- Academic Medical Center, Department of Urology, University of Amsterdam, Amsterdam, Netherlands
| | - Otto M van Delden
- Academic Medical Center, Department of Radiology, University of Amsterdam, Amsterdam, Netherlands
| | - Ton G van Leeuwen
- Academic Medical Center, Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, Netherlands
| | - Jean Jmch de la Rosette
- Academic Medical Center, Department of Urology, University of Amsterdam, Amsterdam, Netherlands
| | - M Pilar Laguna
- Academic Medical Center, Department of Urology, University of Amsterdam, Amsterdam, Netherlands
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van den Bos W, Jurhill R, de Bruin D, Savci-Heijink C, Postema A, Wagstaff P, Muller B, Varkarakis I, Skolarikos A, Zondervan P, Laguna Pes M, de Reijke T, de la Rosette J. Histopathological Outcomes after Irreversible Electroporation for Prostate Cancer: Results of an Ablate and Resect Study. J Urol 2016; 196:552-9. [PMID: 27004693 DOI: 10.1016/j.juro.2016.02.2977] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2016] [Indexed: 12/18/2022]
Affiliation(s)
- W. van den Bos
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - R.R. Jurhill
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - D.M. de Bruin
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - C.D. Savci-Heijink
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - A.W. Postema
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - P.G.K. Wagstaff
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - B.G. Muller
- Department of Urology, 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. Skolarikos
- 2nd Department of Urology, Athens Medical University, University of Athens, Athens, Greece
| | - P.J. Zondervan
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - M.P. Laguna Pes
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - T.M. de Reijke
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J.J.M.C.H. de la Rosette
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Comparative Effects of Irreversible Electroporation, Radiofrequency Ablation, and Partial Nephrectomy on Renal Function Preservation in a Porcine Solitary Kidney Model. Urology 2016; 94:281-7. [DOI: 10.1016/j.urology.2016.04.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 04/21/2016] [Accepted: 04/26/2016] [Indexed: 12/12/2022]
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Wagstaff PGK, Buijs M, van den Bos W, de Bruin DM, Zondervan PJ, de la Rosette JJMCH, Laguna Pes MP. Irreversible electroporation: state of the art. Onco Targets Ther 2016; 9:2437-46. [PMID: 27217767 PMCID: PMC4853139 DOI: 10.2147/ott.s88086] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The field of focal ablative therapy for the treatment of cancer is characterized by abundance of thermal ablative techniques that provide a minimally invasive treatment option in selected tumors. However, the unselective destruction inflicted by thermal ablation modalities can result in damage to vital structures in the vicinity of the tumor. Furthermore, the efficacy of thermal ablation intensity can be impaired due to thermal sink caused by large blood vessels in the proximity of the tumor. Irreversible electroporation (IRE) is a novel ablation modality based on the principle of electroporation or electropermeabilization, in which electric pulses are used to create nanoscale defects in the cell membrane. In theory, IRE has the potential of overcoming the aforementioned limitations of thermal ablation techniques. This review provides a description of the principle of IRE, combined with an overview of in vivo research performed to date in the liver, pancreas, kidney, and prostate.
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Affiliation(s)
- Peter GK Wagstaff
- Department of Urology, Academic Medical Center, Amsterdam, the Netherlands
| | - Mara Buijs
- Department of Urology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Daniel M de Bruin
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | | | | | - M Pilar Laguna Pes
- Department of Urology, Academic Medical Center, Amsterdam, the Netherlands
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Sharabi S, Kos B, Last D, Guez D, Daniels D, Harnof S, Mardor Y, Miklavcic D. A statistical model describing combined irreversible electroporation and electroporation-induced blood-brain barrier disruption. Radiol Oncol 2016; 50:28-38. [PMID: 27069447 PMCID: PMC4825337 DOI: 10.1515/raon-2016-0009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/03/2016] [Indexed: 12/11/2022] Open
Abstract
Background Electroporation-based therapies such as electrochemotherapy (ECT) and irreversible electroporation (IRE) are emerging as promising tools for treatment of tumors. When applied to the brain, electroporation can also induce transient blood-brain-barrier (BBB) disruption in volumes extending beyond IRE, thus enabling efficient drug penetration. The main objective of this study was to develop a statistical model predicting cell death and BBB disruption induced by electroporation. This model can be used for individual treatment planning. Material and methods Cell death and BBB disruption models were developed based on the Peleg-Fermi model in combination with numerical models of the electric field. The model calculates the electric field thresholds for cell kill and BBB disruption and describes the dependence on the number of treatment pulses. The model was validated using in vivo experimental data consisting of rats brains MRIs post electroporation treatments. Results Linear regression analysis confirmed that the model described the IRE and BBB disruption volumes as a function of treatment pulses number (r2 = 0.79; p < 0.008, r2 = 0.91; p < 0.001). The results presented a strong plateau effect as the pulse number increased. The ratio between complete cell death and no cell death thresholds was relatively narrow (between 0.88-0.91) even for small numbers of pulses and depended weakly on the number of pulses. For BBB disruption, the ratio increased with the number of pulses. BBB disruption radii were on average 67% ± 11% larger than IRE volumes. Conclusions The statistical model can be used to describe the dependence of treatment-effects on the number of pulses independent of the experimental setup.
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Affiliation(s)
| | - Bor Kos
- University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia
| | - David Last
- The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel
| | - David Guez
- The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel
| | | | | | | | - Damijan Miklavcic
- University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia
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Liu SP, Li XY, Chen SY, Cheng BB. Application of nanoknife ablation in unresectable pancreatic carcinoma: Present situation and prospects. Shijie Huaren Xiaohua Zazhi 2016; 24:542-548. [DOI: 10.11569/wcjd.v24.i4.542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Pancreatic cancer is a common malignant tumor of the digestive system with rapid progression and poor prognosis. The pathogenesis of pancreatic cancer is still unclear. Its incidence of is significantly rising, ranking fourth among all malignant tumors. Up to now, main therapeutic methods for pancreatic cancer contain surgical treatment, local ablation therapy, local radiotherapy, systemic chemotherapy, molecular targeted therapy, biological treatment and so on. Surgical treatment is still the only way to cure pancreatic cancer. However, most cases of pancreatic cancer are diagnosed at advanced stages, and only 20% of patients have a resectable disease. With the development of medical technology, nanoknife ablation, which is based on irreversible electroporation (IRE), has already come into people's vision. Both animal experiments and clinical studies have showed promising results. In this paper, we will discuss the present situation and prospects of application of nanometer knife ablation in the treatment of unresectable pancreatic carcinoma.
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Sano MB, Arena CB, Bittleman KR, DeWitt MR, Cho HJ, Szot CS, Saur D, Cissell JM, Robertson J, Lee YW, Davalos RV. Bursts of Bipolar Microsecond Pulses Inhibit Tumor Growth. Sci Rep 2015; 5:14999. [PMID: 26459930 PMCID: PMC4602310 DOI: 10.1038/srep14999] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/02/2015] [Indexed: 02/06/2023] Open
Abstract
Irreversible electroporation (IRE) is an emerging focal therapy which is demonstrating utility in the treatment of unresectable tumors where thermal ablation techniques are contraindicated. IRE uses ultra-short duration, high-intensity monopolar pulsed electric fields to permanently disrupt cell membranes within a well-defined volume. Though preliminary clinical results for IRE are promising, implementing IRE can be challenging due to the heterogeneous nature of tumor tissue and the unintended induction of muscle contractions. High-frequency IRE (H-FIRE), a new treatment modality which replaces the monopolar IRE pulses with a burst of bipolar pulses, has the potential to resolve these clinical challenges. We explored the pulse-duration space between 250 ns and 100 μs and determined the lethal electric field intensity for specific H-FIRE protocols using a 3D tumor mimic. Murine tumors were exposed to 120 bursts, each energized for 100 μs, containing individual pulses 1, 2, or 5 μs in duration. Tumor growth was significantly inhibited and all protocols were able to achieve complete regressions. The H-FIRE protocol substantially reduces muscle contractions and the therapy can be delivered without the need for a neuromuscular blockade. This work shows the potential for H-FIRE to be used as a focal therapy and merits its investigation in larger pre-clinical models.
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Affiliation(s)
- Michael B. Sano
- School of Biomedical Engineering and Sciences, Virginia Tech, USA
- Department of Radiation Oncology, Division of Radiation Physics, Stanford University, USA
| | | | | | | | - Hyung J. Cho
- School of Biomedical Engineering and Sciences, Virginia Tech, USA
| | | | | | | | - John Robertson
- School of Biomedical Engineering and Sciences, Virginia Tech, USA
| | - Yong W. Lee
- School of Biomedical Engineering and Sciences, Virginia Tech, USA
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Wendler JJ, Ricke J, Pech M, Fischbach F, Jürgens J, Siedentopf S, Roessner A, Porsch M, Baumunk D, Schostak M, Köllermann J, Liehr UB. First Delayed Resection Findings After Irreversible Electroporation (IRE) of Human Localised Renal Cell Carcinoma (RCC) in the IRENE Pilot Phase 2a Trial. Cardiovasc Intervent Radiol 2015; 39:239-50. [PMID: 26341653 DOI: 10.1007/s00270-015-1200-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/07/2015] [Indexed: 01/14/2023]
Abstract
INTRODUCTION It is postulated that focal IRE affords complete ablation of soft-tissue tumours while protecting the healthy peritumoral tissue. Therefore, IRE may be an interesting option for minimally invasive, kidney-tissue-sparing, non-thermal ablation of renal tumours. AIM With this current pilot study ("IRENE trial"), we present the first detailed histopathological data of IRE of human RCC followed by delayed tumour resection. The aim of this interim analysis of the first three patients was to investigate the ablation efficiency of percutaneous image-guided focal IRE in RCC, to assess whether a complete ablation of T1a RCC and tissue preservation with the NanoKnife system is possible and to decide whether the ablation parameters need to be altered. METHODS Following resection 4 weeks after percutaneous IRE, the success of ablation and detailed histopathological description were used to check the ablation parameters. RESULTS The IRE led to a high degree of damage to the renal tumours (1 central, 2 peripheral; size range 15-17 mm). The postulated homogeneous, isomorphic damage was only partly confirmed. We found a zonal structuring of the ablation zone, negative margins and, enclosed within the ablation zone, very small tumour residues of unclear malignancy. CONCLUSION According to these initial, preliminary study results of the first three renal cases, a new zonal distribution of IRE damage was described and the curative intended, renal saving focal ablation of localised RCC below <3 cm by percutaneous IRE by the NanoKnife system appears to be possible, but needs further, systematic evaluation for this treatment method and treatment protocol.
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Affiliation(s)
- Johann Jakob Wendler
- Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Jens Ricke
- Department of Radiology, University of Magdeburg, Magdeburg, Germany.
| | - Maciej Pech
- Department of Radiology, University of Magdeburg, Magdeburg, Germany.
| | - Frank Fischbach
- Department of Radiology, University of Magdeburg, Magdeburg, Germany.
| | - Julian Jürgens
- Department of Radiology, University of Magdeburg, Magdeburg, Germany.
| | - Sandra Siedentopf
- Institute of Pathology, University of Magdeburg, Magdeburg, Germany.
| | - Albert Roessner
- Institute of Pathology, University of Magdeburg, Magdeburg, Germany.
| | - Markus Porsch
- Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Daniel Baumunk
- Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Martin Schostak
- Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Jens Köllermann
- Institute of Pathology, Sana Klinikum Offenbach Am Main, Offenbach Am Main, Germany.
| | - Uwe-Bernd Liehr
- Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
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Minimally Invasive Percutaneous Treatment of Small Renal Tumors with Irreversible Electroporation: A Single-Center Experience. J Vasc Interv Radiol 2015; 26:1465-71. [PMID: 26250855 DOI: 10.1016/j.jvir.2015.06.028] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/19/2015] [Accepted: 06/20/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To evaluate whether irreversible electroporation (IRE) can be used as an ablation technique for small renal tumors (T1a cancers or small benign tumors) and to describe features after ablation on computed tomography (CT) or magnetic resonance (MR) imaging. MATERIALS AND METHODS In this retrospective study, 20 patients (mean age, 65 y ± 12.8 y) underwent CT-guided IRE of T1a renal carcinoma (n = 13) or small benign or indeterminate renal masses < 4 cm in size (n = 7). Mean tumor size was 2.2 cm ± 0.7. The ablation area was verified with contrast-enhanced imaging performed immediately after the procedure to determine technical success. Imaging was performed 6 weeks (20 of 20 patients), 6 months (15 of 20), and 12 months (6 of 20) after ablation. Medical records and CT/MR imaging features of all patients were reviewed for recurrence, symptoms, and complications after treatment. RESULTS Technical success was achieved in all patients (100%); there were no major procedure-related complications. Minor complications occurred in 7 patients, including self-limiting perinephric hematomas, pain difficult to control, and urinary retention. Mean procedure time was 2.0 hours ± 0.7. At 6 weeks, 2 patients required salvage therapy because of incomplete ablation. At 6 months, all 15 patients with imaging studies available had no evidence of recurrence. At 1 year, 1 patient (1 of 6) was noted to have experienced recurrence. CT/MR imaging after IRE ablation demonstrated an area of nonenhancement in the treatment zone that involuted over ~6 months. CONCLUSIONS Renal IRE appears to be a safe treatment for small renal tumors. Tumors treated with IRE demonstrated nonenhancement in the treatment zone with involution on follow-up CT/MR imaging.
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Les traitements ablatifs dans le cancer du rein localisé : revue de la littérature en 2014. Prog Urol 2015; 25:499-509. [DOI: 10.1016/j.purol.2015.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 04/27/2015] [Accepted: 04/29/2015] [Indexed: 01/25/2023]
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Wendler JJ, Porsch M, Nitschke S, Köllermann J, Siedentopf S, Pech M, Fischbach F, Ricke J, Schostak M, Liehr UB. A prospective Phase 2a pilot study investigating focal percutaneous irreversible electroporation (IRE) ablation by NanoKnife in patients with localised renal cell carcinoma (RCC) with delayed interval tumour resection (IRENE trial). Contemp Clin Trials 2015; 43:10-9. [PMID: 25962890 DOI: 10.1016/j.cct.2015.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/30/2015] [Accepted: 05/04/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Focal ablation therapy is playing an increasing role in oncology and may reduce the toxicity of current surgical treatments while achieving adequate oncological benefit. Irreversible electroporation (IRE) has been proposed to be tissue-selective with potential advantages compared with current thermal-ablation technologies or radiotherapy. The aim of this pilot trial is to determine the effectiveness and feasibility of focal percutaneous IRE in patients with localised renal cell cancer as a uro-oncological tumour model. METHODS Prospective, monocentric Phase 2a pilot study following current recommendations, including those of the International Working Group on Image-Guided Tumor Ablation. Twenty patients with kidney tumour (T1aN0M0) will be recruited. This sample permits an appropriate evaluation of the feasibility and effectiveness of image-guided percutaneous IRE ablation of locally confined kidney tumours as well as functional outcomes. Percutaneous biopsy for histopathology will be performed before IRE, with magnetic-resonance imaging one day before and 2, 7, 27 and 112 days after IRE; at 28 days after IRE the tumour region will be completely resected and analysed by ultra-thin-layer histology. DISCUSSION The IRENE study will investigate over a short-term observation period (by magnetic-resonance imaging, post-resection histology and assessment of technical feasibility) whether focal IRE, as a new ablation procedure for soft tissue, is feasible as a percutaneous, tissue-sparing method for complete ablation and cure of localised kidney tumours. Results from the kidney-tumour model can provide guidance for designing an effectiveness and feasibility trial to assess this new ablative technology, particularly in uro-oncology.
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Affiliation(s)
- J J Wendler
- Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Germany.
| | - M Porsch
- Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Germany
| | - S Nitschke
- Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Germany
| | - J Köllermann
- Institute of Pathology, Sana Klinikum Offenbach, Offenbach am Main, Germany
| | - S Siedentopf
- Institute of Pathology, University Hospital, Otto von Guericke University of Magdeburg, Germany
| | - M Pech
- Department of Radiology, University Hospital, Otto von Guericke University of Magdeburg, Germany
| | - F Fischbach
- Department of Radiology, University Hospital, Otto von Guericke University of Magdeburg, Germany
| | - J Ricke
- Department of Radiology, University Hospital, Otto von Guericke University of Magdeburg, Germany
| | - M Schostak
- Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Germany
| | - U B Liehr
- Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Germany
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Irreversible electroporation of the porcine kidney: Temperature development and distribution. Urol Oncol 2015; 33:168.e1-7. [DOI: 10.1016/j.urolonc.2014.11.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 01/28/2023]
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Wagstaff PGK, de Bruin DM, Zondervan PJ, Savci Heijink CD, Engelbrecht MRW, van Delden OM, van Leeuwen TG, Wijkstra H, de la Rosette JJMCH, Laguna Pes MP. The efficacy and safety of irreversible electroporation for the ablation of renal masses: a prospective, human, in-vivo study protocol. BMC Cancer 2015; 15:165. [PMID: 25886058 PMCID: PMC4376341 DOI: 10.1186/s12885-015-1189-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/12/2015] [Indexed: 01/20/2023] Open
Abstract
Background Electroporation is a novel treatment technique utilizing electric pulses, traveling between two or more electrodes, to ablate targeted tissue. The first in human studies have proven the safety of IRE for the ablation of renal masses. However the efficacy of IRE through histopathological examination of an ablated renal tumour has not yet been studied. Before progressing to a long-term IRE follow-up study it is vital to have pathological confirmation of the efficacy of the technique. Furthermore, follow-up after IRE ablation requires a validated imaging modality. The primary objectives of this study are the safety and the efficacy of IRE ablation of renal masses. The secondary objectives are the efficacy of MRI and CEUS in the imaging of ablation result. Methods/Design 10 patients, age ≥ 18 years, presenting with a solid enhancing mass, who are candidates for radical nephrectomy will undergo IRE ablation 4 weeks prior to radical nephrectomy. MRI and CEUS imaging will be performed at baseline, one week and four weeks post IRE. After radical nephrectomy, pathological examination will be performed to evaluate IRE ablation success. Discussion The only way to truly assess short-term (4 weeks) ablation success is by histopathology of a resection specimen. In our opinion this trial will provide essential knowledge on the safety and efficacy of IRE of renal masses, guiding future research of this promising ablative technique. Trial registration Clinicaltrials.gov registration number NCT02298608. Dutch Central Committee on Research Involving Human Subjects registration number NL44785.018.13
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Affiliation(s)
- Peter G K Wagstaff
- Department of Urology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - Daniel M de Bruin
- Department of Urology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands. .,Department of Biomedical Engineering & Physics, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - Patricia J Zondervan
- Department of Urology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - C Dilara Savci Heijink
- Department of Pathology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - Marc R W Engelbrecht
- Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - Otto M van Delden
- Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - Ton G van Leeuwen
- Department of Biomedical Engineering & Physics, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - Hessel Wijkstra
- Department of Urology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands. .,Department of Electrical Engineering, Eindhoven University of Technology, Den Dolech 2, 5612 AZ, Eindhoven, Netherlands.
| | | | - M Pilar Laguna Pes
- Department of Urology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
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Srimathveeravalli G, Silk M, Wimmer T, Monette S, Kimm S, Maybody M, Solomon SB, Coleman J, Durack JC. Feasibility of catheter-directed intraluminal irreversible electroporation of porcine ureter and acute outcomes in response to increasing energy delivery. J Vasc Interv Radiol 2015; 26:1059-66. [PMID: 25769212 DOI: 10.1016/j.jvir.2015.01.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 01/03/2015] [Accepted: 01/19/2015] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate the feasibility of focal intraluminal irreversible electroporation (IRE) in the ureter with a novel electrode catheter and to study the treatment effects in response to increasing pulse strength. MATERIALS AND METHODS Five IRE treatment settings were each evaluated twice for the ablation of normal ureter in 5 Yorkshire pigs (n = 1-4 ablations per animal; total of 10 ablations) with the use of a prototype device under ultrasound and fluoroscopic guidance. Animals received unilateral or bilateral treatment, limited to a maximum of 2 ablations in any 1 ureter. Treatment was delivered with increasing pulse strength (from 1,000 V to 3,000 V in increments of 500 V) while keeping the pulse duration (100 μs) and number of pulses (n = 90) constant. Ureter patency was assessed with antegrade ureteropyelography immediately following treatment. Animals were euthanized within 4 hours after treatment, and treated urinary tract was harvested for histopathologic analysis with hematoxylin and eosin and Masson trichrome stains. RESULTS IRE was successfully performed in all animals, without evidence of ureteral perforation. Hematoxylin and eosin analysis of IRE treatments demonstrated full-thickness ablation at higher field strengths (mucosa to the adventitia). Masson trichrome stains showed preservation of connective tissue at all field strengths. CONCLUSIONS Intraluminal catheter-directed IRE ablation is feasible and produces full-thickness ablation of normal ureters. There was no evidence of lumen perforation even at the maximum voltages evaluated.
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Affiliation(s)
| | - Mikhail Silk
- Department of Radiology, Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Thomas Wimmer
- Department of Radiology, Medical University of Graz, Graz, Austria
| | - Sebastien Monette
- Tri-Institutional Laboratory of Comparative Pathology, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, and The Rockefeller University, New York, New York
| | - Simon Kimm
- Department of Surgery, Division of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Majid Maybody
- Department of Radiology, Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Stephen B Solomon
- Department of Radiology, Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jonathan Coleman
- Department of Surgery, Division of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jeremy C Durack
- Department of Radiology, Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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Garcia PA, Davalos RV, Miklavcic D. A numerical investigation of the electric and thermal cell kill distributions in electroporation-based therapies in tissue. PLoS One 2014; 9:e103083. [PMID: 25115970 PMCID: PMC4130512 DOI: 10.1371/journal.pone.0103083] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/27/2014] [Indexed: 12/18/2022] Open
Abstract
Electroporation-based therapies are powerful biotechnological tools for enhancing the delivery of exogeneous agents or killing tissue with pulsed electric fields (PEFs). Electrochemotherapy (ECT) and gene therapy based on gene electrotransfer (EGT) both use reversible electroporation to deliver chemotherapeutics or plasmid DNA into cells, respectively. In both ECT and EGT, the goal is to permeabilize the cell membrane while maintaining high cell viability in order to facilitate drug or gene transport into the cell cytoplasm and induce a therapeutic response. Irreversible electroporation (IRE) results in cell kill due to exposure to PEFs without drugs and is under clinical evaluation for treating otherwise unresectable tumors. These PEF therapies rely mainly on the electric field distributions and do not require changes in tissue temperature for their effectiveness. However, in immediate vicinity of the electrodes the treatment may results in cell kill due to thermal damage because of the inhomogeneous electric field distribution and high current density during the electroporation-based therapies. Therefore, the main objective of this numerical study is to evaluate the influence of pulse number and electrical conductivity in the predicted cell kill zone due to irreversible electroporation and thermal damage. Specifically, we simulated a typical IRE protocol that employs ninety 100-µs PEFs. Our results confirm that it is possible to achieve predominant cell kill due to electroporation if the PEF parameters are chosen carefully. However, if either the pulse number and/or the tissue conductivity are too high, there is also potential to achieve cell kill due to thermal damage in the immediate vicinity of the electrodes. Therefore, it is critical for physicians to be mindful of placement of electrodes with respect to critical tissue structures and treatment parameters in order to maintain the non-thermal benefits of electroporation and prevent unnecessary damage to surrounding healthy tissue, critical vascular structures, and/or adjacent organs.
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Affiliation(s)
- Paulo A. Garcia
- Bioelectromechanical Systems Laboratory, Virginia Tech – Wake Forest University, Blacksburg, Virginia, United States of America
| | - Rafael V. Davalos
- Bioelectromechanical Systems Laboratory, Virginia Tech – Wake Forest University, Blacksburg, Virginia, United States of America
| | - Damijan Miklavcic
- University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia
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Silk M, Tahour D, Srimathveeravalli G, Solomon SB, Thornton RH. The state of irreversible electroporation in interventional oncology. Semin Intervent Radiol 2014; 31:111-7. [PMID: 25053862 DOI: 10.1055/s-0034-1373785] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A new ablation modality, irreversible electroporation (IRE), has been of increasing interest in interventional radiology. Its nonthermal mechanism of action of killing tumor cells allows physicians the ability to ablate tumors in areas previously contraindicated for thermal ablation. This article reviews the current published clinical outcomes, imaging follow-up, and the current knowledge gaps in the procedure for patients treated with IRE.
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Affiliation(s)
- Mikhail Silk
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David Tahour
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Govindarajan Srimathveeravalli
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen B Solomon
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raymond H Thornton
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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Abstract
PURPOSE OF REVIEW Thermal ablation of urologic tumors in the form of freezing (cryoablation) and heating (radiofrequency ablation) have been utilized successfully to treat and ablate soft tissue tumors for over 15 years. Multiple studies have demonstrated efficacy nearing that of extirpative surgery for certain urologic conditions. There are technical limitations to their speed and safety profile because of the physical limits of thermal diffusion. RECENT FINDINGS Recently, there has been a desire to investigate other forms of energy in an effort to circumvent the limitations of cryoblation and radiofrequency ablation. This review will focus on three relatively new energy applications as they pertain to tissue ablation: microwave, irreversible electroporation, and water vapor. High-intensity-focused ultrasound nor interstitial lasers are discussed, as there have been no recently published updates. SUMMARY Needle and probe-based ablative treatments will continue to play an important role. As three-dimensional imaging workstations move from the advanced radiologic interventional suite to the operating room, surgeons will likely still play a pivotal role in the +-application of these probe ablative devices. It is essential that the surgeon understands the fundamentals of these devices in order to optimize their application.
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Abstract
Image-guided ablation has evolved rapidly in the past decade into a competitive technique for treating focal solid malignancies. However, as they rely mainly on thermal energy, such as radiofrequency or microwave, many tumors close to sensitive organs, such as ducts, bowel, and nerves, still remain nonablatable owing to the risk of thermal injury. Irreversible electroporation is a novel ablation modality that relies largely on a nonthermal mechanism to induce cell death, and therefore may overcome many of the shortcomings of thermal ablation. Emerging preclinical data as well as early clinical experience is showing promise for this technique in treating a variety of tumors including periportal liver masses, pancreatic cancer, perihilar renal tumors, prostate cancer, and other soft tissue tumors. However, practical limitations remain for irreversible electroporation, and its complete cancer and location-specific safety and efficacy profiles are still largely unknown. We therefore review what is known for this new ablation modality based on preclinical and preliminary clinical data, and discuss its emerging indications as well as technical challenges.
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Affiliation(s)
- David S K Lu
- Division of Abdominal Imaging and Intervention, Department of Radiology, UCLA Medical Center, Los Angeles, CA.
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Abstract
Tumor ablation is a minimally invasive technique that is commonly used in the treatment of tumors of the liver, kidney, bone, and lung. During tumor ablation, thermal energy is used to heat or cool tissue to cytotoxic levels (less than -40°C or more than 60°C). An additional technique is being developed that targets the permeability of the cell membrane and is ostensibly nonthermal. Within the classification of tumor ablation, there are several modalities used worldwide: radiofrequency, microwave, laser, high-intensity focused ultrasound, cryoablation, and irreversible electroporation. Each technique, although similar in purpose, has specific and optimal indications. This review serves to discuss general principles and technique, reviews each modality, and discusses modality selection.
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Affiliation(s)
- Erica M Knavel
- Department of Radiology, University of Wisconsin Madison, Clinical Sciences Center, Madison, WI.
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Planning irreversible electroporation in the porcine kidney: are numerical simulations reliable for predicting empiric ablation outcomes? Cardiovasc Intervent Radiol 2014; 38:182-90. [PMID: 24831827 DOI: 10.1007/s00270-014-0905-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 04/02/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE Numerical simulations are used for treatment planning in clinical applications of irreversible electroporation (IRE) to determine ablation size and shape. To assess the reliability of simulations for treatment planning, we compared simulation results with empiric outcomes of renal IRE using computed tomography (CT) and histology in an animal model. METHODS The ablation size and shape for six different IRE parameter sets (70-90 pulses, 2,000-2,700 V, 70-100 µs) for monopolar and bipolar electrodes was simulated using a numerical model. Employing these treatment parameters, 35 CT-guided IRE ablations were created in both kidneys of six pigs and followed up with CT immediately and after 24 h. Histopathology was analyzed from postablation day 1. RESULTS Ablation zones on CT measured 81 ± 18 % (day 0, p ≤ 0.05) and 115 ± 18 % (day 1, p ≤ 0.09) of the simulated size for monopolar electrodes, and 190 ± 33 % (day 0, p ≤ 0.001) and 234 ± 12 % (day 1, p ≤ 0.0001) for bipolar electrodes. Histopathology indicated smaller ablation zones than simulated (71 ± 41 %, p ≤ 0.047) and measured on CT (47 ± 16 %, p ≤ 0.005) with complete ablation of kidney parenchyma within the central zone and incomplete ablation in the periphery. CONCLUSION Both numerical simulations for planning renal IRE and CT measurements may overestimate the size of ablation compared to histology, and ablation effects may be incomplete in the periphery.
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Silk MT, Wimmer T, Lee KS, Srimathveeravalli G, Brown KT, Kingham PT, Fong Y, Durack JC, Sofocleous CT, Solomon SB. Percutaneous ablation of peribiliary tumors with irreversible electroporation. J Vasc Interv Radiol 2013; 25:112-8. [PMID: 24262034 DOI: 10.1016/j.jvir.2013.10.012] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 10/11/2013] [Accepted: 10/11/2013] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess biliary complications after irreversible electroporation (IRE) ablation of hepatic tumors located < 1 cm from major bile ducts. MATERIALS AND METHODS A retrospective review was conducted of all percutaneous IRE ablations of hepatic tumors within 1 cm of the common, left, or right hepatic ducts at a single institution from January 2011 to September 2012. Computed tomography imaging performed before and after treatment was examined for evidence of bile duct dilatation, stricture, or leakage. Serum bilirubin and alkaline phosphatase levels were analyzed for evidence of biliary injury. RESULTS There were 22 hepatic metastases in 11 patients with at least one tumor within 1 cm of the common, left, or right hepatic duct that were treated with IRE ablations in 15 sessions. Median tumor size treated was 3.0 cm (mean, 2.8 cm ± 1.2, range, 1.0-4.7 cm). Laboratory values obtained after IRE were considered abnormal after four treatment sessions in three patients (bilirubin, 2.6-17.6 mg/dL; alkaline phosphatase, 130-1,035 U/L); these abnormal values were transient in two sessions. Two patients had prolonged elevation of values, and one required stent placement; both of these conditions appeared to be secondary to tumor progression rather than bile duct injury. CONCLUSIONS This clinical experience suggests that IRE may be a treatment option for centrally located liver tumors with margins adjacent to major bile ducts where thermal ablation techniques are contraindicated. Further studies with extended follow-up periods are necessary to establish the safety profile of IRE in this setting.
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Affiliation(s)
- Mikhail T Silk
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065.
| | - Thomas Wimmer
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065; Department of Radiology, Medical University of Graz, Graz, Austria
| | - Kyungmouk S Lee
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065
| | - Govindarajan Srimathveeravalli
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065
| | - Karren T Brown
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065
| | - Peter T Kingham
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065
| | - Yuman Fong
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065
| | - Jeremy C Durack
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065
| | - Constantinos T Sofocleous
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065
| | - Stephen B Solomon
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 444 East 68th Street, New York, NY 10065
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