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Kwon JH, Kim MD, Kim SH, Lee EW, Kahlid SA. Effects of irreversible electroporation on femoral nerves in a rabbit model. MINIM INVASIV THER 2020; 31:306-312. [PMID: 32744129 DOI: 10.1080/13645706.2020.1799820] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Irreversible electroporation (IRE) is a novel technique that uses a non-thermal ablation to avoid adjacent major structure injury. The aim of this study was to sequentially evaluate the effects of IRE on the femoral nerve during acute-to-delayed periods in a rabbit model. MATERIAL AND METHODS Ultrasound-guided IRE of femoral neurovascular bundles was performed in seven rabbits. Functional and histopathologic evaluation was performed sequentially after IRE. The extent of nerve fiber affected, and the proportion of perineurial inflammation and surrounding tissue injury were recorded. RESULTS After IRE, femoral nerve function was damaged before four weeks, but then gradually returned to normal. Perineural inflammatory cell infiltration was most severe three days after IRE (80-85%), and was normalized after eight weeks. Surrounding tissue injury was prominent at three days and one week after IRE (80-90%), and then gradually recovered. However, peripheral nerve fibers were markedly damaged at one and two weeks (80-100%). Nerve fibers then recovered and were normalized at eight weeks. CONCLUSION Nerve tissue injury with transient functional impairment can occur after IRE. However, endoneurial and epineurial extracellular matrix were preserved with Schwann cell regeneration, which could lead to regeneration of nerve tissues within eight weeks.
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Affiliation(s)
- Joon Ho Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Man-Deuk Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Hoon Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Edward W Lee
- Division of Interventional Radiology, Department of Radiology, Ronald Reagan Medical Center at UCLA Medical Center, Los Angeles, CA, USA
| | - Suliman Aljoqiman Kahlid
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Radiology, King Faisal University College of Medicine, Al-Ahsa, Saudi Arabia
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Collettini F, Enders J, Stephan C, Fischer T, Baur ADJ, Penzkofer T, Busch J, Hamm B, Gebauer B. Image-guided Irreversible Electroporation of Localized Prostate Cancer: Functional and Oncologic Outcomes. Radiology 2019; 292:250-257. [PMID: 31161973 DOI: 10.1148/radiol.2019181987] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Irreversible electroporation (IRE) is a nonthermal ablative method based on the formation of nanoscale defects in cell membranes leading to cell death. Clinical experience with the technique for treatment of prostate cancer remains limited. Purpose To evaluate urogenital toxicity and oncologic outcome of MRI-transrectal US fusion-guided IRE of localized prostate cancer. Materials and Methods In this prospective study, men with biopsy-proven, treatment-naive, low- to intermediate-risk prostate cancer (prostate-specific antigen [PSA], ≤15 ng/mL; Gleason score, ≤3 + 4; clinical stage, ≤T2c; lesion size at multiparametric MRI, ≤20 mm) underwent focal MRI/transrectal US fusion-guided IRE between July 2014 and July 2017. Primary end point was the urogenital toxicity profile of focal IRE by using participant-reported questionnaires. Secondary end points were biochemical, histologic, and imaging measures of oncologic control. Analyses were performed by using nonparametric and χ2 test statistics. Results Thirty men were included (median age, 65.5 years); mean PSA level was 8.65 ng/mL and mean tumor size was 13.5 mm. One grade III adverse event (urethral stricture) was recorded. The proportion of men with erection sufficient for penetration was 83.3% (25 of 30) at baseline and 79.3% (23 of 29; P > .99) at 12 months. Leak-free and pad-free continence rate was 90% (27 of 30) at baseline and 86.2% (25 of 29; P > .99) at 12 months. Urogenital function remained stable at 12 months according to changes in the modified International Consultation on Incontinence Questionnaire Male Lower Urinary Tract Symptoms, or ICIQ-MLUTS, and the International Index of Erectile Function, or IIEF-5, questionnaires (P = .58 and P = .07, respectively). PSA level decreased from a baseline median value of 8.65 ng/mL (interquartile range, 5-11.4 ng/mL) to 2.35 ng/mL (interquartile range, 1-3.4 ng/mL) at 12 months (P < .001). At 6 months, 28 of 30 participants underwent posttreatment biopsy. The rate of in-field treatment failure was 17.9% (five of 28) as determined with multiparametric prostate MRI and targeted biopsies at 6 months. Conclusion After a median follow-up of 20 months, focal irreversible electroporation of localized prostate cancer was associated with low urogenital toxicity and promising oncologic outcomes. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Federico Collettini
- From the Departments of Radiology (F.C., J.E., T.F., A.D.J.B., T.P., B.H.) and Urology (C.S., J.B., B.G.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health, Berlin, Germany (F.C., T.P.); and Department of Urology, Berlin Institute for Urologic Research, Berlin, Germany (C.S.)
| | - Judith Enders
- From the Departments of Radiology (F.C., J.E., T.F., A.D.J.B., T.P., B.H.) and Urology (C.S., J.B., B.G.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health, Berlin, Germany (F.C., T.P.); and Department of Urology, Berlin Institute for Urologic Research, Berlin, Germany (C.S.)
| | - Carsten Stephan
- From the Departments of Radiology (F.C., J.E., T.F., A.D.J.B., T.P., B.H.) and Urology (C.S., J.B., B.G.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health, Berlin, Germany (F.C., T.P.); and Department of Urology, Berlin Institute for Urologic Research, Berlin, Germany (C.S.)
| | - Thomas Fischer
- From the Departments of Radiology (F.C., J.E., T.F., A.D.J.B., T.P., B.H.) and Urology (C.S., J.B., B.G.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health, Berlin, Germany (F.C., T.P.); and Department of Urology, Berlin Institute for Urologic Research, Berlin, Germany (C.S.)
| | - Alexander D J Baur
- From the Departments of Radiology (F.C., J.E., T.F., A.D.J.B., T.P., B.H.) and Urology (C.S., J.B., B.G.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health, Berlin, Germany (F.C., T.P.); and Department of Urology, Berlin Institute for Urologic Research, Berlin, Germany (C.S.)
| | - Tobias Penzkofer
- From the Departments of Radiology (F.C., J.E., T.F., A.D.J.B., T.P., B.H.) and Urology (C.S., J.B., B.G.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health, Berlin, Germany (F.C., T.P.); and Department of Urology, Berlin Institute for Urologic Research, Berlin, Germany (C.S.)
| | - Jonas Busch
- From the Departments of Radiology (F.C., J.E., T.F., A.D.J.B., T.P., B.H.) and Urology (C.S., J.B., B.G.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health, Berlin, Germany (F.C., T.P.); and Department of Urology, Berlin Institute for Urologic Research, Berlin, Germany (C.S.)
| | - Bernd Hamm
- From the Departments of Radiology (F.C., J.E., T.F., A.D.J.B., T.P., B.H.) and Urology (C.S., J.B., B.G.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health, Berlin, Germany (F.C., T.P.); and Department of Urology, Berlin Institute for Urologic Research, Berlin, Germany (C.S.)
| | - Bernhard Gebauer
- From the Departments of Radiology (F.C., J.E., T.F., A.D.J.B., T.P., B.H.) and Urology (C.S., J.B., B.G.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health, Berlin, Germany (F.C., T.P.); and Department of Urology, Berlin Institute for Urologic Research, Berlin, Germany (C.S.)
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