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Tang S, Gao Y, Yan X, Zhi W, Han Y. Effectiveness and safety of vascular intervention plus lenvatinib versus vascular intervention alone for hepatocellular carcinoma patients with portal vein tumor thrombus: a retrospective comparative study. Front Oncol 2024; 14:1431069. [PMID: 39035736 PMCID: PMC11257876 DOI: 10.3389/fonc.2024.1431069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/17/2024] [Indexed: 07/23/2024] Open
Abstract
Background This study aimed to assess the effectiveness and safety of vascular intervention combined with lenvatinib versus vascular intervention alone in the treatment of advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT), and to identify prognostic factors associated with the treatment outcomes. Methods We conducted a retrospective analysis of data from 92 patients with advanced HCC and PVTT who were treated between February 2016 and February 2023. Among them, 56 patients underwent vascular intervention alone (transarterial chemoembolization, TACE), while 36 patients received vascular intervention (TACE or hepatic arterial infusion chemotherapy [HAIC]) combined with lenvatinib. The primary outcomes included progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). Survival rates were estimated by the Kaplan-Meier method, and confounders were adjusted using inverse probability of treatment weighting (IPTW). Prognostic factors were determined through the Cox regression model. Results The median follow-up duration was 20.07 months (interquartile range: 6.41-25.36). The combination therapy group had a significantly longer median PFS (11.00 vs. 5.00 months, P<0.05) and OS (12.91 vs. 6.83 months, P<0.05) in comparison to the monotherapy group, and these findings remained consistent after IPTW matching. Moreover, the combination therapy group showed a higher ORR (55.56% vs. 26.79%, P<0.05) based on mRECIST criteria. Cox multivariate analysis identified extrahepatic metastasis and maximum tumor diameter as risk factors for PFS, while age, tumor number, and maximum tumor diameter influenced OS. Combined treatment emerged as a protective factor for OS. In the combination therapy group, hypertension was the most frequent adverse event, with grade 3 or 4 adverse events occurring rarely. Conclusion The combination of vascular intervention with lenvatinib has demonstrated improved PFS and OS in advanced HCC patients with PVTT, and its safety profile appears to be acceptable. Adoption of this combined treatment strategy at an earlier stage may enhance patient outcomes.
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Affiliation(s)
- Saikang Tang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingming Gao
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue Yan
- Department of General Surgery, Cancer Hospital of Huanxing, Beijing, China
| | - Weihua Zhi
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Han
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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2
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Scuderi M, Dermol-Cerne J, Scancar J, Markovic S, Rems L, Miklavcic D. The equivalence of different types of electric pulses for electrochemotherapy with cisplatin - an in vitro study. Radiol Oncol 2024; 58:51-66. [PMID: 38378034 PMCID: PMC10878774 DOI: 10.2478/raon-2024-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Electrochemotherapy (ECT) is a treatment involving the administration of chemotherapeutics drugs followed by the application of 8 square monopolar pulses of 100 μs duration at a repetition frequency of 1 Hz or 5000 Hz. However, there is increasing interest in using alternative types of pulses for ECT. The use of high-frequency short bipolar pulses has been shown to mitigate pain and muscle contractions. Conversely, the use of millisecond pulses is interesting when combining ECT with gene electrotransfer for the uptake of DNA-encoding proteins that stimulate the immune response with the aim of converting ECT from a local to systemic treatment. Therefore, the aim of this study was to investigate how alternative types of pulses affect the efficiency of the ECT. MATERIALS AND METHODS We performed in vitro experiments, exposing Chinese hamster ovary (CHO) cells to conventional ECT pulses, high-frequency bipolar pulses, and millisecond pulses in the presence of different concentrations of cisplatin. We determined cisplatin uptake by inductively coupled plasma mass spectrometry and cisplatin cytotoxicity by the clonogenic assay. RESULTS We observed that the three tested types of pulses potentiate the uptake and cytotoxicity of cisplatin in an equivalent manner, provided that the electric field is properly adjusted for each pulse type. Furthermore, we quantified that the number of cisplatin molecules, resulting in the eradication of most cells, was 2-7 × 107 per cell. CONCLUSIONS High-frequency bipolar pulses and millisecond pulses can potentially be used in ECT to reduce pain and muscle contraction and increase the effect of the immune response in combination with gene electrotransfer, respectively.
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Affiliation(s)
- Maria Scuderi
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Janja Dermol-Cerne
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Janez Scancar
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
- Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Stefan Markovic
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
- Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Lea Rems
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Damijan Miklavcic
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
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3
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Lim M, Kim J, Rhu J, Choi GS, Joh JW. Liver resection in selective hepatocellular carcinoma with Vp3 or Vp4 portal vein tumor thrombosis improves prognosis. JOURNAL OF LIVER CANCER 2024; 24:102-112. [PMID: 38351676 PMCID: PMC10990670 DOI: 10.17998/jlc.2024.01.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND/AIM Hepatocellular carcinoma (HCC) tumor thrombi located in the first branch of the portal vein (Vp3) or in the main portal trunk (Vp4) are associated with poor prognosis. This study aimed to investigate the clinicopathological characteristics and risk factors for HCC recurrence and mortality following liver resection (LR) in patients with Vp3 or Vp4 HCC. METHODS The study included 64 patients who underwent LR for HCC with Vp3 or Vp4 portal vein tumor thrombosis (PVTT). RESULTS Fifty-eight patients (90.6%) had Vp3 PVTT, whereas the remaining six patients exhibited Vp4 PVTT. The median tumor size measured 8 cm, with approximately 36% of patients presented with multiple tumors. Fifty-four patients (84.4%) underwent open LR, whereas 10 patients underwent laparoscopic LR. In the Vp4 cases, combined LR and tumor thrombectomy were performed. The 3-year cumulative disease-free survival rate was 42.8% for the Vp3 group and 22.2% for the Vp4 group. The overall survival (OS) rate at 3 years was 47.9% for the Vp3 group and 60.0% for the Vp4 group. Intrahepatic metastasis has been identified as an important contributor to HCC recurrence. High hemoglobin levels are associated with high mortality. CONCLUSION LR is a safe and effective treatment modality for selected patients with Vp3 or Vp4 HCC PVTT. This suggests that LR is a viable option for these patients, with favorable outcomes in terms of OS.
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Affiliation(s)
- Manuel Lim
- Department of Surgery, Myoungji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Jongman Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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4
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Martin CH, Martin RCG. Optimal Dosing and Patient Selection for Electrochemotherapy in Solid Abdominal Organ and Bone Tumors. Bioengineering (Basel) 2023; 10:975. [PMID: 37627860 PMCID: PMC10451240 DOI: 10.3390/bioengineering10080975] [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: 07/10/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
The primary aim of this study was to analyze studies that use electrochemotherapy (ECT) in "deep-seated" tumors in solid organs (liver, kidney, bone metastasis, pancreas, and abdomen) and understand the similarities between patient selection, oncologic selection, and use of new procedures and technology across the organ systems to assess response rates. A literature search was conducted using the term "Electrochemotherapy" in the title field using publications from 2017 to 2023. After factoring in inclusion and exclusion criteria, 29 studies were analyzed and graded based on quality in full. The authors determined key patient and oncologic selection characteristics and ECT technology employed across organ systems that yielded overall responses, complete responses, and partial responses of the treated tumor. It was determined that key selection factors included: the ability to be administered bleomycin, life expectancy greater than three months, unrespectability of the lesion being treated, and a later stage, more advanced cancer. Regarding oncologic selection, all patient cohorts had received chemotherapy or surgery previously but had disease recurrence, making ECT the only option for further treatment. Lastly, in terms of the use of technology, the authors found that studies with better response rates used the ClinporatorTM and updated procedural guidelines by SOP. Thus, by considering patient, oncologic, and technology selection, ECT can be further improved in treating lesions in solid organs.
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Affiliation(s)
| | - Robert C. G. Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40202, USA
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5
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Campelo SN, Huang PH, Buie CR, Davalos RV. Recent Advancements in Electroporation Technologies: From Bench to Clinic. Annu Rev Biomed Eng 2023; 25:77-100. [PMID: 36854260 DOI: 10.1146/annurev-bioeng-110220-023800] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Over the past decade, the increased adoption of electroporation-based technologies has led to an expansion of clinical research initiatives. Electroporation has been utilized in molecular biology for mammalian and bacterial transfection; for food sanitation; and in therapeutic settings to increase drug uptake, for gene therapy, and to eliminate cancerous tissues. We begin this article by discussing the biophysics required for understanding the concepts behind the cell permeation phenomenon that is electroporation. We then review nano- and microscale single-cell electroporation technologies before scaling up to emerging in vivo applications.
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Affiliation(s)
- Sabrina N Campelo
- Department of Biomedical Engineering and Mechanics, Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Virginia Tech, Blacksburg, Virginia, USA;
| | - Po-Hsun Huang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Cullen R Buie
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Rafael V Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Virginia Tech, Blacksburg, Virginia, USA;
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6
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Barca I, Ferragina F, Kallaverja E, Arrotta A, Cristofaro MG. Electrochemotherapy as an Effective Alternative in the Treatment of Local Advanced Oral Squamous Cell Carcinoma: A Retrospective Analysis of Treated Cases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5170. [PMID: 36982078 PMCID: PMC10049161 DOI: 10.3390/ijerph20065170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 06/18/2023]
Abstract
Advanced oral squamous cell carcinomas represent a major challenge for maxillofacial surgeons, oncologists and radiation therapists. They also account for a large share of healthcare costs. They respond little and/or poorly to conventional therapies (surgery, radiotherapy and chemotherapy). Electrochemotherapy is a new method used as a palliative treatment in patients with advanced cancer of the neck/head region who are not eligible for standard therapies. It combines the use of cytotoxic drugs with the physical principle of electroporation; it effectively controls the tumour locally and preserves organ function. To date, ECT has been little used for oral mucosal tumours, as this is difficult to access for electrodes. We report six cases of advanced oral squamous cell carcinoma treated with electrochemotherapy. This study aims to assess the debulking effect of cancer via ECT in patients with advanced oral squamous cell carcinoma. It also aims to assess the safety and tolerability of this treatment.
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Affiliation(s)
- Ida Barca
- Unit of Maxillofacial Surgery, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Francesco Ferragina
- Unit of Maxillofacial Surgery, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Elvis Kallaverja
- Unit of Maxillofacial Surgery, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Antonella Arrotta
- Department of Medical and Surgical Sciences, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Maria Giulia Cristofaro
- Unit of Maxillofacial Surgery, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
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7
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Granata V, Fusco R, D’Alessio V, Simonetti I, Grassi F, Silvestro L, Palaia R, Belli A, Patrone R, Piccirillo M, Izzo F. Percutanous Electrochemotherapy (ECT) in Primary and Secondary Liver Malignancies: A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13020209. [PMID: 36673019 PMCID: PMC9858594 DOI: 10.3390/diagnostics13020209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023] Open
Abstract
The aim of the study was to analyse papers describing the use of Electrochemotherapy (ECT) in local treatment of primary and secondary liver tumours located at different sites and with different histologies. Other Local Ablative Therapies (LAT) are also discussed. Analyses of these papers demonstrate that ECT use is safe and effective in lesions of large size, independently of the histology of the treated lesions. ECT performed better than other thermal ablation techniques in lesions > 6 cm in size and can be safely used to treat lesions distant, close, or adjacent to vital structures. ECT spares vessel and bile ducts, is repeatable, and can be performed between chemotherapeutic cycles. ECT can fill the gap in local ablative therapies due to being lesions too large or localized in highly challenging anatomical sites.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Roberta Fusco
- Oncology Medical and Research & Development Division, Casalnuovo di Napoli, 80013 Naples, Italy
| | - Valeria D’Alessio
- Oncology Medical and Research & Development Division, Casalnuovo di Napoli, 80013 Naples, Italy
- Correspondence:
| | - Igino Simonetti
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Francesca Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80127 Naples, Italy
| | - Lucrezia Silvestro
- Division of Clinical Experimental Oncology Abdomen, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Raffaele Palaia
- Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Andrea Belli
- Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Renato Patrone
- Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Mauro Piccirillo
- Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Francesco Izzo
- Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
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8
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Comments on "The beneficial role of electrochemotherapy in locally advanced pancreatic cancer - radiological perspective". Pol J Radiol 2022; 87:e668-e669. [PMID: 36643010 PMCID: PMC9834069 DOI: 10.5114/pjr.2022.123567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/07/2022] [Indexed: 01/03/2023] Open
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9
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Tasu JP, Tougeron D, Rols MP. Irreversible electroporation and electrochemotherapy in oncology: State of the art. Diagn Interv Imaging 2022; 103:499-509. [DOI: 10.1016/j.diii.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 01/10/2023]
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10
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Granata V, Palaia R, Izzo F. Commentary: The Synergistic Role of Irreversible Electroporation and Chemotherapy for Locally Advanced Pancreatic Cancer. Front Oncol 2022; 12:955444. [PMID: 36185275 PMCID: PMC9521203 DOI: 10.3389/fonc.2022.955444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Vincenza Granata
- Division of Radiology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy
- *Correspondence: Vincenza Granata,
| | - Raffaele Palaia
- Division of Hepatobiliary Surgical Oncology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy
| | - Francesco Izzo
- Division of Hepatobiliary Surgical Oncology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy
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11
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Justesen TF, Orhan A, Raskov H, Nolsoe C, Gögenur I. Electroporation and Immunotherapy-Unleashing the Abscopal Effect. Cancers (Basel) 2022; 14:cancers14122876. [PMID: 35740542 PMCID: PMC9221311 DOI: 10.3390/cancers14122876] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 01/10/2023] Open
Abstract
Simple Summary Electrochemotherapy and irreversible electroporation are primarily used for treating patients with cutaneous and subcutaneous tumors and pancreatic cancer, respectively. Increasing numbers of studies have shown that the treatments may elicit an immune response in addition to eliminating the tumor cells. The purpose of this review is to give an in-depth introduction to the electroporation-induced immune response and the local and peripheral immune systems, and to describe the various studies investigating the combination of electroporation and immunotherapy. The review may help guide and inspire the design of future clinical trials investigating the potential synergy of electroporation and immunotherapy in cancer treatment. Abstract The discovery of electroporation in 1968 has led to the development of electrochemotherapy (ECT) and irreversible electroporation (IRE). ECT and IRE have been established as treatments of cutaneous and subcutaneous tumors and locally advanced pancreatic cancer, respectively. Interestingly, the treatment modalities have been shown to elicit immunogenic cell death, which in turn can induce an immune response towards the tumor cells. With the dawn of the immunotherapy era, the potential of combining ECT and IRE with immunotherapy has led to the launch of numerous studies. Data from the first clinical trials are promising, and new combination regimes might change the way we treat tumors characterized by low immunogenicity and high levels of immunosuppression, such as melanoma and pancreatic cancer. In this review we will give an introduction to ECT and IRE and discuss the impact on the immune system. Additionally, we will present the results of clinical and preclinical trials, investigating the combination of electroporation modalities and immunotherapy.
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Affiliation(s)
- Tobias Freyberg Justesen
- Center for Surgical Science, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark; (A.O.); (H.R.); (I.G.)
- Correspondence:
| | - Adile Orhan
- Center for Surgical Science, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark; (A.O.); (H.R.); (I.G.)
| | - Hans Raskov
- Center for Surgical Science, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark; (A.O.); (H.R.); (I.G.)
| | - Christian Nolsoe
- Center for Surgical Ultrasound, Department of Surgery, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark;
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Ryesgade 53B, 2100 Copenhagen, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark; (A.O.); (H.R.); (I.G.)
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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Granata V, Fusco R, De Muzio F, Cutolo C, Setola SV, Simonetti I, Dell’Aversana F, Grassi F, Bruno F, Belli A, Patrone R, Pilone V, Petrillo A, Izzo F. Complications Risk Assessment and Imaging Findings of Thermal Ablation Treatment in Liver Cancers: What the Radiologist Should Expect. J Clin Med 2022; 11:jcm11102766. [PMID: 35628893 PMCID: PMC9147303 DOI: 10.3390/jcm11102766] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023] Open
Abstract
One of the major fields of application of ablation treatment is liver tumors. With respect to HCC, ablation treatments are considered as upfront treatments in patients with early-stage disease, while in colorectal liver metastases (CLM), they can be employed as an upfront treatment or in association with surgical resection. The main prognostic feature of ablation is the tumor size, since the goal of the treatment is the necrosis of all viable tumor tissue with an adequate tumor-free margin. Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most employed ablation techniques. Ablation therapies in HCC and liver metastases have presented a challenge to radiologists, who need to assess response to determine complication-related treatment. Complications, defined as any unexpected variation from a procedural course, and adverse events, defined as any actual or potential injury related to the treatment, could occur either during the procedure or afterwards. To date, RFA and MWA have shown no statistically significant differences in mortality rates or major or minor complications. To reduce the rate of major complications, patient selection and risk assessment are essential. To determine the right cost-benefit ratio for the ablation method to be used, it is necessary to identify patients at high risk of infections, coagulation disorders and previous abdominal surgery interventions. Based on risk assessment, during the procedure as part of surveillance, the radiologists should pay attention to several complications, such as vascular, biliary, mechanical and infectious. Multiphase CT is an imaging tool chosen in emergency settings. The radiologist should report technical success, treatment efficacy, and complications. The complications should be assessed according to well-defined classification systems, and these complications should be categorized consistently according to severity and time of occurrence.
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Affiliation(s)
- Vincenza Granata
- Radiology Division, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (S.V.S.); (I.S.); (A.P.)
- Correspondence:
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy;
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy;
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.C.); (V.P.)
| | - Sergio Venanzio Setola
- Radiology Division, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (S.V.S.); (I.S.); (A.P.)
| | - Igino Simonetti
- Radiology Division, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (S.V.S.); (I.S.); (A.P.)
| | - Federica Dell’Aversana
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.D.); (F.G.)
| | - Francesca Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.D.); (F.G.)
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy;
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Andrea Belli
- Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (A.B.); (R.P.); (F.I.)
| | - Renato Patrone
- Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (A.B.); (R.P.); (F.I.)
| | - Vincenzo Pilone
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.C.); (V.P.)
| | - Antonella Petrillo
- Radiology Division, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (S.V.S.); (I.S.); (A.P.)
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (A.B.); (R.P.); (F.I.)
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13
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Electrochemotherapy of Primary Colon Rectum Cancer and Local Recurrence: Case Report and Prospective Analysis. J Clin Med 2022; 11:jcm11102745. [PMID: 35628872 PMCID: PMC9143872 DOI: 10.3390/jcm11102745] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 12/21/2022] Open
Abstract
Purpose: Surgery, radiotherapy, and oncological treatment (chemotherapy and antineoplastic antibodies) are standard treatments of rectal cancer. ECT has shown its effectiveness and suitability in deep solid tumors conducted in both preclinical and clinical studies. We show here an update and preliminary results with locally advanced rectum cancer (LARC) treated with ECT. Methods: Two patients with major clinical response to restaging after neoadjuvant treatment for LARC were subjected to ECT 12 weeks after completing chemo-radiation therapy. One patient was subjected to ECT on a colorectal local recurrence formed after neoadjuvant treatment for LARC and surgery. Computed Tomography and Magnetic Resonance Imaging were used to assess ECT response. Results: The results showed stable disease in two of the three patients treated, while one patient achieved a complete response. The local control of disease is maintained in the patient follow-up. For each patient, a reduction in pain was observed and for the patient with local recurrence, a reduction in bleeding present before ECT was also achieved. Conclusion: Preliminary results showed that ECT is a safe and effective treatment in patients with a major clinical response or local recurrence after neoadjuvant therapy for LARC and allows a reduction in pain and bleeding with a consequent improvement to quality of life.
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Cindric H, Gasljevic G, Edhemovic I, Brecelj E, Zmuc J, Cemazar M, Seliskar A, Miklavcic D, Kos B. Numerical mesoscale tissue model of electrochemotherapy in liver based on histological findings. Sci Rep 2022; 12:6476. [PMID: 35444226 PMCID: PMC9021251 DOI: 10.1038/s41598-022-10426-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/07/2022] [Indexed: 11/09/2022] Open
Abstract
Electrochemotherapy (ECT) and irreversible electroporation (IRE) are being investigated for treatment of hepatic tumours. The liver is a highly heterogeneous organ, permeated with a network of macro- and microvasculature, biliary tracts and connective tissue. The success of ECT and IRE depends on sufficient electric field established in whole target tissue; therefore, tissue heterogeneity may affect the treatment outcome. In this study, we investigate electroporation in the liver using a numerical mesoscale tissue model. We numerically reconstructed four ECT experiments in healthy porcine liver and computed the electric field distribution using our treatment planning framework. We compared the computed results with histopathological changes identified on microscopic images after treatment. The mean electric field threshold that best fitted the zone of coagulation necrosis was 1225 V/cm, while the mean threshold that best fitted the zone of partially damaged liver parenchyma attributed to IRE was 805 V/cm. We evaluated how the liver macro- and microstructures affect the electric field distribution. Our results show that the liver microstructure does not significantly affect the electric field distribution on the level needed for treatment planning. However, major hepatic vessels and portal spaces significantly affect the electric field distribution, and should be considered when planning treatments.
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Affiliation(s)
- Helena Cindric
- Faculty of Electrical Engineering, University of Ljubljana, Trzaska cesta 25, 1000, Ljubljana, Slovenia
| | - Gorana Gasljevic
- Institute of Oncology Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia
| | - Ibrahim Edhemovic
- Institute of Oncology Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Erik Brecelj
- Institute of Oncology Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia
| | - Jan Zmuc
- Institute of Oncology Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Maja Cemazar
- Institute of Oncology Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia.,Faculty of Health Sciences, University of Primorska, Polje 42, 6310, Izola, Slovenia
| | - Alenka Seliskar
- University of Ljubljana, Veterinary Faculty, Gerbiceva ulica 60, 1000, Ljubljana, Slovenia
| | - Damijan Miklavcic
- Faculty of Electrical Engineering, University of Ljubljana, Trzaska cesta 25, 1000, Ljubljana, Slovenia
| | - Bor Kos
- Faculty of Electrical Engineering, University of Ljubljana, Trzaska cesta 25, 1000, Ljubljana, Slovenia.
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15
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Tao ZW, Cheng BQ, Zhou T, Gao YJ. Management of hepatocellular carcinoma patients with portal vein tumor thrombosis: A narrative review. Hepatobiliary Pancreat Dis Int 2022; 21:134-144. [PMID: 34955380 DOI: 10.1016/j.hbpd.2021.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/05/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the main reasons for malignancy-related death. Portal vein tumor thrombosis (PVTT) is the most common form of macrovascular invasion related to HCC occurring in 10%-60% of patients. HCC with PVTT is usually characterized by worsening liver function, vulnerability to blood metastasis, higher incidence of complications associated with portal hypertension, and intolerance to treatment when compared with that without PVTT. If only treated with supportive care, the median survival of HCC with PVTT is about 2.7 months. In the past, sorafenib was the only recommended therapy by guidelines with limited effectiveness. This narrative review aimed to describe the current management options for HCC with PVTT. DATA SOURCES We have reviewed literature from PubMed on the treatment of HCC with PVTT and compiled evidence-based facts on effective therapies available for different types of PVTT. RESULTS Sorafenib monotherapy is not much effective, but combining it with other methods can improve survival. Each type of PVTT can benefit from the combination of transarterial chemoembolization and sorafenib than sorafenib monotherapy. The tumor downstaging can be realized possibly after transarterial chemoembolization, but tumor invasion into the main trunk of the portal vein greatly impairs efficacy. Although surgery is a curative approach, it is often not recommended for Vp4 PVTT. Some new methods can broaden the indication, but further explorations are needed. Radiotherapy can decrease the possibility of Vp3 progression to Vp4, but building a forecast model of best radiation dose and response is necessary. Systemic chemotherapy, hepatic arterial infusion chemotherapy, radiofrequency ablation, portal stenting, and traditional Chinese medicine are also beneficial in Vp3-4 PVTT. The accurate diagnosis of PVTT can be made by radiomics, and prognostic classification models can be used to design personalized treatments. The application of new treatment methods such as the atezolizumab plus bevacizumab scheme may increase survival. CONCLUSIONS HCC with PVTT is still a thorny problem, and effective therapeutics need to be explored.
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Affiliation(s)
- Zi-Wen Tao
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Bao-Quan Cheng
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Tao Zhou
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Yan-Jing Gao
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China.
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Percutaneous electrochemotherapy in primary and secondary liver malignancies - local tumor control and impact on overall survival. Radiol Oncol 2022; 56:102-110. [PMID: 35148468 PMCID: PMC8884851 DOI: 10.2478/raon-2022-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background Local nonsurgical tumor ablation currently represents a further option for the treatment of patients with liver tumors or metastases. Electrochemotherapy (ECT) is a welcome addition to the portfolio of local therapies. A retrospective analysis of patients with liver tumors or metastases treated with ECT is reported. Attention is given to the safety and efficacy of the treatment over time. Patients and methods Eighteen consecutive patients were recruited with measurable liver tumors of different histopatologic origins, mainly colorectal cancer, breast cancer, and hepatocellular cancer. They were treated with percutaneous ECT following the standard operating procedures (SOP) for ECT under general anaesthesia and muscle relaxation. Treatment planning was performed based on MRI preoperative images. The follow-up assessment included contrast-enhanced MR within at least 1–3 months after treatment and then after 5, 7, 9, 12, and 18 months until progression of the disease or death. Results Only mild or moderate side effects were observed after ECT. The objective response rate was 85.7% (complete response 61.9%, partial 23.8%), the mean progression-free survival (PFS) was 9.0 ± 8.2 months, and the overall survival (OS) was 11.3 ± 8.6 months. ECT performed best (PFS and OS) in lesions within 3 and 6 cm diameters (p = 0.0242, p = 0.0297). The effectiveness of ECT was independent of the localization of the lesions: distant, close or adjacent to vital structures. Progression-free survival and overall survival were independent of the primary histology considered. Conclusions Electrochemotherapy provides an effective valuable option for the treatment of unresectable liver metastases not amenable to other ablative techniques.
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Trotovšek B, Djokić M, Čemažar M, Serša G. New era of electrochemotherapy in treatment of liver tumors in conjunction with immunotherapies. World J Gastroenterol 2021; 27:8216-8226. [PMID: 35068866 PMCID: PMC8717013 DOI: 10.3748/wjg.v27.i48.8216] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/28/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023] Open
Abstract
Electrochemotherapy is a local ablative therapy that increases the cytotoxicity of either bleomycin or cisplatin by applying electric pulses (electroporation) to tumors. It has already been widely used throughout Europe for the treatment of various types of human and veterinary cutaneous tumors, with an objective response rate ranging from 70%-90%, depending on the tumor histotype. Recently, electrochemotherapy was introduced for the treatment of primary liver tumors, such as hepatocellular carcinoma (HCC). The complete response rate was 85% per treated lesion, with a durable response. Therefore, electrochemotherapy could become a treatment of choice for HCC, especially after achieving a transition from an open surgery approach to a percutaneous approach that uses dedicated electrodes. Electrochemotherapy elicits a local immune response and can be considered an in situ vaccination. HCC, among others, is a potentially immunogenic tumor; thus, electrochemotherapy could boost adjuvant immunotherapy to achieve a better and longer-lasting antitumor response. Therefore, therapeutic strategies that combine electrochemotherapy with immune checkpoint inhibitors or adjuvant treatment with cytokines are indicated for HCC. Immunogene therapy using electroporation as a delivery system for plasmid DNA coding for interleukin-12 is a highly promising approach. This electroporation approach has shown efficacy in preclinical settings and veterinary oncology and is awaiting translation for the treatment of liver tumors, i.e., HCC.
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Affiliation(s)
- Blaž Trotovšek
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- Medical Faculty Ljubljana, University of Ljubljana, Ljubljana 1000, Slovenia
| | - Mihajlo Djokić
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- Medical Faculty Ljubljana, University of Ljubljana, Ljubljana 1000, Slovenia
| | - Maja Čemažar
- Department of Experimental Oncology, Institute of Oncology, Ljubljana 1000, Slovenia
- Faculty of Health Sciences, University of Primorska, Izola 6310, Slovenia
| | - Gregor Serša
- Department of Experimental Oncology, Institute of Oncology, Ljubljana 1000, Slovenia
- Faculty of Health Sciences, University of Ljubljana, Ljubljana 1000, Slovenia
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18
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A Multicenter Randomized Controlled Prospective Study to Assess Efficacy of Laparoscopic Electrochemotherapy in the Treatment of Locally Advanced Pancreatic Cancer. J Clin Med 2021; 10:jcm10174011. [PMID: 34501459 PMCID: PMC8432461 DOI: 10.3390/jcm10174011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Eighty percent of patients with pancreatic adenocarcinoma present a locally advanced or metastatic disease at diagnosis and are not eligible for surgery if not with palliative intent. In cases of locally advanced disease (LAPC), the combination of chemo and radiotherapy is the only therapeutic option and correlates with a median survival of 15 months (10 months without treatment), with partial remission of disease in 50% of cases. The feasibility and safety of Electrochemotherapy (ECT) have been demonstrated in the treatment of deep tumors. Aim: The aim of the study is to evaluate the efficacy of electrochemotherapy (ECT) followed by conventional systemic treatment compared to the only conventional systemic treatment in LAPC in terms of objective response and overall survival. Patients and Methods: This study is a phase IIb prospective multicenter randomized controlled trial with two arms. The study will include 90 patients: 45 in the control group and 45 in the experimental group. Patients with LAPC in the control arm will receive conventional chemotherapy (FOLFOXIRI). Patients with LAPC in the experimental arm will be subjected to Electrochemotherapy and subsequently to FOLFOXIRI. The objective response at 30, 90, and 180 days from treatment will be based on the computed tomography (CT), magnetic resonance (MR), and positron emission tomography/CT response (PET/CT). The objective long-term treatment response will be evaluated with the modified response evaluation criteria in solid tumors (m-RECIST) criteria, which will take into account the difference in vascularization, determined by the images obtained by CT and MR of the tumor treated before and after ECT. Conclusions: Not resectable liver metastasis, pancreatic tumors, and locally advanced renal carcinomas can be treated with laparoscopic electrodes. ECT could represent an effective therapeutic option for patients not eligible for surgery susceptible to be managed only with palliative therapies.
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19
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Granata V, Grassi R, Fusco R, Belli A, Cutolo C, Pradella S, Grazzini G, La Porta M, Brunese MC, De Muzio F, Ottaiano A, Avallone A, Izzo F, Petrillo A. Diagnostic evaluation and ablation treatments assessment in hepatocellular carcinoma. Infect Agent Cancer 2021; 16:53. [PMID: 34281580 PMCID: PMC8287696 DOI: 10.1186/s13027-021-00393-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/06/2021] [Indexed: 02/07/2023] Open
Abstract
This article provides an overview of diagnostic evaluation and ablation treatment assessment in Hepatocellular Carcinoma (HCC). Only studies, in the English language from January 2010 to January 202, evaluating the diagnostic tools and assessment of ablative therapies in HCC patients were included. We found 173 clinical studies that satisfied the inclusion criteria.HCC may be noninvasively diagnosed by imaging findings. Multiphase contrast-enhanced imaging is necessary to assess HCC. Intravenous extracellular contrast agents are used for CT, while the agents used for MRI may be extracellular or hepatobiliary. Both gadoxetate disodium and gadobenate dimeglumine may be used in hepatobiliary phase imaging. For treatment-naive patients undergoing CT, unenhanced imaging is optional; however, it is required in the post treatment setting for CT and all MRI studies. Late arterial phase is strongly preferred over early arterial phase. The choice of modality (CT, US/CEUS or MRI) and MRI contrast agent (extracelllar or hepatobiliary) depends on patient, institutional, and regional factors. MRI allows to link morfological and functional data in the HCC evaluation. Also, Radiomics is an emerging field in the assessment of HCC patients.Postablation imaging is necessary to assess the treatment results, to monitor evolution of the ablated tissue over time, and to evaluate for complications. Post- thermal treatments, imaging should be performed at regularly scheduled intervals to assess treatment response and to evaluate for new lesions and potential complications.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Roberta Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
- Italian Society of Medical and Interventional Radiology SIRM, SIRM Foundation, Milan, Italy
| | | | - Andrea Belli
- Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Silvia Pradella
- Radiology Division, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Grazzini
- Radiology Division, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Maria Chiara Brunese
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Alessandro Ottaiano
- Abdominal Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Antonio Avallone
- Abdominal Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Francesco Izzo
- Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Antonella Petrillo
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
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20
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Cucu CI, Giurcăneanu C, Popa LG, Orzan OA, Beiu C, Holban AM, Grumezescu AM, Matei BM, Popescu MN, Căruntu C, Mihai MM. Electrochemotherapy and Other Clinical Applications of Electroporation for the Targeted Therapy of Metastatic Melanoma. MATERIALS 2021; 14:ma14143985. [PMID: 34300902 PMCID: PMC8305146 DOI: 10.3390/ma14143985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/10/2021] [Accepted: 07/11/2021] [Indexed: 12/21/2022]
Abstract
Electrochemotherapy (ECT) is an effective bioelectrochemical procedure that uses controlled electrical pulses to facilitate the increase of intracellular concentration of certain substances (electropermeabilization/ reversible electroporation). ECT using antitumor drugs such as bleomycin and cisplatin is a minimally invasive targeted therapy that can be used as an alternative for oncologic patients not eligible for surgery or other standard therapies. Even though ECT is mainly applied as palliative care for metastases, it may also be used for primary tumors that are unresectable due to size and location. Skin neoplasms are the main clinical indication of ECT, the procedure reporting good curative results and high efficiency across all tumor types, including melanoma. In daily practice, there are many cases in which the patient’s quality of life can be significantly improved by a safe procedure such as ECT. Its popularity must be increased because it has a safe profile and minor local adverse reactions. The method can be used by dermatologists, oncologists, and surgeons. The aim of this paper is to review recent literature concerning electrochemotherapy and other clinical applications of electroporation for the targeted therapy of metastatic melanoma.
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Affiliation(s)
- Corina Ioana Cucu
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
| | - Călin Giurcăneanu
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
| | - Liliana Gabriela Popa
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
- Correspondence: ; Tel.: +40-727-173-767
| | - Olguța Anca Orzan
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
| | - Cristina Beiu
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
| | - Alina Maria Holban
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest, 030018 Bucharest, Romania;
- Research Institute of the University of Bucharest, 050657 Bucharest, Romania
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 1-7 Polizu Street, 011061 Bucharest, Romania;
| | - Alexandru Mihai Grumezescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 1-7 Polizu Street, 011061 Bucharest, Romania;
| | - Bogdan Mircea Matei
- Department of Biophysics and Cellular Biotechnology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Marius Nicolae Popescu
- Department of Physical and Rehabilitation Medicine, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Constantin Căruntu
- Faculty of Medicine, “Titu Maiorescu” University, 22 Dambrovnicului, 031593 Bucharest, Romania;
| | - Mara Mădălina Mihai
- Department of Oncologic Dermatology-“Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.C.); (C.G.); (O.A.O.); (C.B.); (M.M.M.)
- Research Institute of the University of Bucharest, 050657 Bucharest, Romania
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21
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Rega D, Granata V, Petrillo A, Pace U, Sassaroli C, Di Marzo M, Cervone C, Fusco R, D’Alessio V, Nasti G, Romano C, Avallone A, Pecori B, Botti G, Tatangelo F, Maiolino P, Delrio P. Organ Sparing for Locally Advanced Rectal Cancer after Neoadjuvant Treatment Followed by Electrochemotherapy. Cancers (Basel) 2021; 13:cancers13133199. [PMID: 34206858 PMCID: PMC8267997 DOI: 10.3390/cancers13133199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 12/21/2022] Open
Abstract
Simple Summary This is a Phase II randomized controlled trial conducted with the aim of investigating whether the use of Electrochemotherapy after neoadjuvant therapy (ECT) and before surgery in patients with major clinical response allows for a more conservative surgical approach in patients with Locally Advanced Rectal Cancer (LARC) in comparison with the control group that will not receive ECT. The treatment response, in both the control arm and in the treatment arm, will be assessed using the histopathological tumor regression grade on tissue specimens after local excision. Abstract Background: Currently, 45–55% of rectal cancer patients receive preoperative chemo- radio-therapy for Locally Advanced Rectal Cancer (LARC). The idea of our study is to use Electrochemotherapy (ECT) before surgery, in patients with major clinical response after neoadjuvant therapy, to allow for a more conservative surgical approach. Objective: To evaluate the increase of the complete response rate after neoadjuvant treatment in LARC and to spare organ function due to total mesorectal excision (TME). Patients and Methods: This is a Phase II randomized controlled trial enrolling 70 patients that will be developed in two stages. In the first step, 28 patients will be enrolled: 14 of these will receive ECT for four weeks after neo-adjuvant treatment and then local excision (treatment group) and 14 patients will receive neo-adjuvant treatment and then local excision (control group). If an increase of response rate is observed in the first stage, and/or feasibility/safety is demonstrated, the second stage of the trial will be performed, enrolling an additional 42 patients. The treatment response. in both the control arm and the treatment arm, will be assessed using the histopathological tumor regression grade on tissue specimens after local excision.
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Affiliation(s)
- Daniela Rega
- Division of Colorectal Surgery, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (D.R.); (U.P.); (C.S.); (M.D.M.); (C.C.); (P.D.)
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy;
- Correspondence:
| | - Antonella Petrillo
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy;
| | - Ugo Pace
- Division of Colorectal Surgery, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (D.R.); (U.P.); (C.S.); (M.D.M.); (C.C.); (P.D.)
| | - Cinzia Sassaroli
- Division of Colorectal Surgery, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (D.R.); (U.P.); (C.S.); (M.D.M.); (C.C.); (P.D.)
| | - Massimiliano Di Marzo
- Division of Colorectal Surgery, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (D.R.); (U.P.); (C.S.); (M.D.M.); (C.C.); (P.D.)
| | - Carmela Cervone
- Division of Colorectal Surgery, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (D.R.); (U.P.); (C.S.); (M.D.M.); (C.C.); (P.D.)
| | - Roberta Fusco
- IGEA SpA Medical Division-Oncology, Via Casarea 65, Casalnuovo di Napoli, I-80013 Napoli, Italy; (R.F.); (V.D.)
| | - Valeria D’Alessio
- IGEA SpA Medical Division-Oncology, Via Casarea 65, Casalnuovo di Napoli, I-80013 Napoli, Italy; (R.F.); (V.D.)
| | - Guglielmo Nasti
- Division of Abdominal Medical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (G.N.); (C.R.); (A.A.)
| | - Carmela Romano
- Division of Abdominal Medical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (G.N.); (C.R.); (A.A.)
| | - Antonio Avallone
- Division of Abdominal Medical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (G.N.); (C.R.); (A.A.)
| | - Biagio Pecori
- Division of Abdominal Radiotherapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy;
| | - Gerardo Botti
- Division of Pathological Anatomy, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (G.B.); (F.T.)
| | - Fabiana Tatangelo
- Division of Pathological Anatomy, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (G.B.); (F.T.)
| | - Piera Maiolino
- Division of Pharmacy, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy;
| | - Paolo Delrio
- Division of Colorectal Surgery, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (D.R.); (U.P.); (C.S.); (M.D.M.); (C.C.); (P.D.)
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Fusco R, Di Bernardo E, D'Alessio V, Salati S, Cadossi M. Reduction of muscle contraction and pain in electroporation-based treatments: An overview. World J Clin Oncol 2021; 12:367-381. [PMID: 34131568 PMCID: PMC8173331 DOI: 10.5306/wjco.v12.i5.367] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/17/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the first studies of electrochemotherapy (ECT), small cutaneous metastases were treated and only mild or moderate pain was observed; therefore, pain was not considered a significant issue. As the procedure began to be applied to larger cutaneous metastases, pain was reported more frequently. For that reason, reduction of both muscle contractions and pain have been investigated over the years.
AIM To present an overview of different protocols described in literature that aim to reduce muscle contractions and pain caused by the electroporation (EP) effect in both ECT and irreversible EP treatments.
METHODS Thirty-three studies published between January 1999 and November 2020 were included. Different protocol designs and electrode geometries that reduce patient pain and the number of muscle contractions and their intensity were analysed.
RESULTS The analysis showed that both high frequency and bipolar/biphasic pulses can be used to reduce pain and muscle contractions in patients who undergo EP treatments. Moreover, adequate electrode design can decrease EP-related morbidity. Particularly, needle length, diameter and configuration of the distance between the needles can be optimised so that the muscle volume crossed by the current is reduced as much as possible. Bipolar/biphasic pulses with an inadequate pulse length seem to have a less evident effect on the membrane permeability compared with the standard pulse protocol. For that reason, the number of pulses and the voltage amplitude, as well as the pulse duration and frequency, must be chosen so that the dose of delivered energy guarantees EP efficacy.
CONCLUSION Pain reduction in EP-based treatments can be achieved by appropriately defining the protocol parameters and electrode design. Most results can be achieved with high frequency and/or bipolar/biphasic pulses. However, the efficacy of these alternative protocols remains a crucial point to be assessed further.
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Affiliation(s)
- Roberta Fusco
- Department of Medical Oncology, IGEA SpA, Carpi 41012, Modena, Italy
| | - Elio Di Bernardo
- Department of Medical Oncology, IGEA SpA, Carpi 41012, Modena, Italy
| | - Valeria D'Alessio
- Department of Medical Oncology, IGEA SpA, Carpi 41012, Modena, Italy
| | - Simona Salati
- Department of Medical Oncology, IGEA SpA, Carpi 41012, Modena, Italy
| | - Matteo Cadossi
- Department of Medical Oncology, IGEA SpA, Carpi 41012, Modena, Italy
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23
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Granata V, Fusco R, Salati S, Petrillo A, Di Bernardo E, Grassi R, Palaia R, Danti G, La Porta M, Cadossi M, Gašljević G, Sersa G, Izzo F. A Systematic Review about Imaging and Histopathological Findings for Detecting and Evaluating Electroporation Based Treatments Response. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115592. [PMID: 34073865 PMCID: PMC8197272 DOI: 10.3390/ijerph18115592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Imaging methods and the most appropriate criteria to be used for detecting and evaluating response to oncological treatments depend on the pathology and anatomical site to be treated and on the treatment to be performed. This document provides a general overview of the main imaging and histopathological findings of electroporation-based treatments (Electrochemotherapy-ECT and Irreversible electroporation-IRE) compared to thermal approach, such as radiofrequency ablation (RFA), in deep-seated cancers with a particular attention to pancreatic and liver cancer. METHODS Numerous electronic datasets were examined: PubMed, Scopus, Web of Science and Google Scholar. The research covered the years from January 1990 to April 2021. All titles and abstracts were analyzed. The inclusion criteria were the following: studies that report imaging or histopathological findings after ablative thermal and not thermal loco-regional treatments (ECT, IRE, RFA) in deep-seated cancers including pancreatic and liver cancer and articles published in the English language. Exclusion criteria were unavailability of full text and congress abstracts or posters and different topic respect to inclusion criteria. RESULTS 558 potentially relevant references through electronic searches were identified. A total of 38 articles met the inclusion criteria: 20 studies report imaging findings after RFA or ECT or IRE in pancreatic and liver cancer; 17 studies report histopathological findings after RFA or ECT or IRE; 1 study reports both imaging and histopathological findings after RFA or ECT or IRE. CONCLUSIONS Imaging features are related to the type of therapy administrated, to the timing of re-assessment post therapy and to the imaging technique being used to observe the effects. Histological findings after both ECT and IRE show that the treated area becomes necrotic and encapsulated in fibrous tissue, suggesting that the size of the treated lesion cannot be measured as an endpoint to detect response. Moreover, histology frequently reported signs of apoptosis and reduced vital tissue, implying that imaging criteria, which take into account the viability and not the size of the lesion, are more appropriate to evaluate response to treatment.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (V.G.); (A.P.)
| | - Roberta Fusco
- Oncology Medical and Research & Development Division, IGEA SpA, I-41012 Carpi, Italy; (S.S.); (E.D.B.); (M.C.)
- Correspondence:
| | - Simona Salati
- Oncology Medical and Research & Development Division, IGEA SpA, I-41012 Carpi, Italy; (S.S.); (E.D.B.); (M.C.)
| | - Antonella Petrillo
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (V.G.); (A.P.)
| | - Elio Di Bernardo
- Oncology Medical and Research & Development Division, IGEA SpA, I-41012 Carpi, Italy; (S.S.); (E.D.B.); (M.C.)
| | - Roberta Grassi
- Radiology Division, Università Degli Studi Della Campania Luigi Vanvitelli, I-80143 Naples, Italy;
- Italian Society of Medical and Interventional Radiology SIRM, SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Raffaele Palaia
- Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (R.P.); (F.I.)
| | - Ginevra Danti
- Radiology Division, Azienda Ospedaliero-Universitaria Careggi, I-50139 Florence, Italy;
| | | | - Matteo Cadossi
- Oncology Medical and Research & Development Division, IGEA SpA, I-41012 Carpi, Italy; (S.S.); (E.D.B.); (M.C.)
| | - Gorana Gašljević
- Department of Pathology, Institute of Oncology Ljubljana, Zaloska cesta 2, SI-1000 Ljubljana, Slovenia;
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska cesta 2, SI-1000 Ljubljana, Slovenia;
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, SI-1000 Ljubljana, Slovenia
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, I-80131 Naples, Italy; (R.P.); (F.I.)
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Perri F, Longo F, Fusco R, D’Alessio V, Aversa C, Pavone E, Pontone M, Marciano ML, Villano S, Franco P, Togo G, Fazio GRD, Ordano D, Maglitto F, Salzano G, Maglione MG, Guida A, Ionna F. Electrochemotherapy as a First Line Treatment in Recurrent Squamous Cell Carcinoma of the Oral Cavity and Oropharynx PDL-1 Negative and/or with Evident Contraindication to Immunotherapy: A Randomized Multicenter Controlled Trial. Cancers (Basel) 2021; 13:cancers13092210. [PMID: 34064511 PMCID: PMC8124504 DOI: 10.3390/cancers13092210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/17/2021] [Accepted: 05/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A significant proportion of patients with head and neck squamous cell carcinoma (HNSCC) have advanced-stage disease (stages III to IVB) that do not respond to therapy despite aggressive, site-specific multimodality therapy. A great number of them will develop disease recurrence, with up to 60% risk of local failure and up to 30% risk of distant failure. Therapy can be very demanding for the patient especially when important anatomical structures are involved. For these reasons, therapies that preserve organ functionality in combination with effective local tumor control, like electrochemotherapy (ECT), are of great interest. Until few months ago, systemic cetuximab + platinum-based therapy + 5-fluorouracil represented the standard treatment for HNSCC relapses with a median overall survival of 10.1 months and an objective response rate of 36%. Recently the results of KEYNOTE-048 study were published and a new combination of monoclonal antibody named pembrolizumab and chemotherapy emerged as standard first line therapy of recurrent or metastatic tumor that overexpress tissue PDL-1 (Programmed Death 1 ligand). Nevertheless, a variable percentage from 10 to 15% of patients with recurrent/metastatic disease have a tumor that does not overexpress tissue PDL-1, and therefore, according to the results of the KEYNOTE-048 study, does not benefit from replacement of cetuximab with pembrolizumab. These patients will be treated with the "gold standard": cetuximab, cisplatin/carboplatin and 5-fluorouracil. AIM To verify whether electrochemotherapy performed with bleomycin of HNSCC relapses of the oral cavity and oropharynx (single relapse on T) is able to lead to an increase in the objective response rate in comparison with the systemic treatment with cetuximab + platinum-based therapy + 5-fluorouracil in patients with PDL-1 negative tumors. METHODS The phase IIb study involves the enrolment of 96 patients who meet the inclusion criteria (48 in the control arm and 48 in the treatment arm). The control arm involves the treatment of HNSCC with systemic treatment (cetuximab + platinum-based therapy + 5-fluorouracil). The treatment arm involves the ECT with bleomycin. The primary objective is to verify the objective response rate of patients in the control arm compared to the treatment arm.
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Affiliation(s)
- Francesco Perri
- Medical and Experimental Head and Neck Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Via M. Semmola, 80131 Naples, Italy; (F.P.); (M.P.); (M.L.M.)
| | - Francesco Longo
- Head and Neck Surgery Unit, Ospedale Casa Sollievo della Sofferenza, S. Giovanni Rotondo, 71013 Foggia, Italy;
| | - Roberta Fusco
- IGEA SpA Medical Division—Oncology, Via Casarea 65, Casalnuovo di Napoli, 80013 Napoli, Italy;
- Correspondence:
| | - Valeria D’Alessio
- IGEA SpA Medical Division—Oncology, Via Casarea 65, Casalnuovo di Napoli, 80013 Napoli, Italy;
| | - Corrado Aversa
- Head and Neck Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Via M. Semmola, 80131 Naples, Italy; (C.A.); (E.P.); (S.V.); (P.F.); (F.M.); (G.S.); (M.G.M.); (F.I.)
| | - Ettore Pavone
- Head and Neck Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Via M. Semmola, 80131 Naples, Italy; (C.A.); (E.P.); (S.V.); (P.F.); (F.M.); (G.S.); (M.G.M.); (F.I.)
| | - Monica Pontone
- Medical and Experimental Head and Neck Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Via M. Semmola, 80131 Naples, Italy; (F.P.); (M.P.); (M.L.M.)
| | - Maria Luisa Marciano
- Medical and Experimental Head and Neck Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Via M. Semmola, 80131 Naples, Italy; (F.P.); (M.P.); (M.L.M.)
| | - Salvatore Villano
- Head and Neck Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Via M. Semmola, 80131 Naples, Italy; (C.A.); (E.P.); (S.V.); (P.F.); (F.M.); (G.S.); (M.G.M.); (F.I.)
| | - Pierluigi Franco
- Head and Neck Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Via M. Semmola, 80131 Naples, Italy; (C.A.); (E.P.); (S.V.); (P.F.); (F.M.); (G.S.); (M.G.M.); (F.I.)
| | - Giulia Togo
- School of Specialization in Maxillo-Facial Surgery, University of Naples Federico II, Via Sergio Pansini, 80131 Naples, Italy; (G.T.); (G.R.D.F.); (D.O.)
| | - Gianluca Renato De Fazio
- School of Specialization in Maxillo-Facial Surgery, University of Naples Federico II, Via Sergio Pansini, 80131 Naples, Italy; (G.T.); (G.R.D.F.); (D.O.)
| | - Daniele Ordano
- School of Specialization in Maxillo-Facial Surgery, University of Naples Federico II, Via Sergio Pansini, 80131 Naples, Italy; (G.T.); (G.R.D.F.); (D.O.)
| | - Fabio Maglitto
- Head and Neck Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Via M. Semmola, 80131 Naples, Italy; (C.A.); (E.P.); (S.V.); (P.F.); (F.M.); (G.S.); (M.G.M.); (F.I.)
| | - Giovanni Salzano
- Head and Neck Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Via M. Semmola, 80131 Naples, Italy; (C.A.); (E.P.); (S.V.); (P.F.); (F.M.); (G.S.); (M.G.M.); (F.I.)
| | - Maria Grazia Maglione
- Head and Neck Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Via M. Semmola, 80131 Naples, Italy; (C.A.); (E.P.); (S.V.); (P.F.); (F.M.); (G.S.); (M.G.M.); (F.I.)
| | - Agostino Guida
- U.O.C. Odontostomatologia, AORN A. Cardarelli, 80131 Naples, Italy;
| | - Franco Ionna
- Head and Neck Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, Via M. Semmola, 80131 Naples, Italy; (C.A.); (E.P.); (S.V.); (P.F.); (F.M.); (G.S.); (M.G.M.); (F.I.)
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Clinical Phase I/II Study: Local Disease Control and Survival in Locally Advanced Pancreatic Cancer Treated with Electrochemotherapy. J Clin Med 2021; 10:jcm10061305. [PMID: 33810058 PMCID: PMC8005134 DOI: 10.3390/jcm10061305] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
Objective. To assess local disease control rates (LDCR) and overall survival (OS) in locally advanced pancreatic cancer (LAPC) treated with electrochemotherapy (ECT). Methods. Electrochemotherapy with bleomycin was performed in 25 LAPC patients who underwent baseline Magnetic Resonance Imaging (MRI) and/or Computed Tomography (CT) and Position Emission Tomography (PET) scans before ECT and 1 and 6 months post ECT. LDCR were assessed using Response Evaluation Criteria in Solid Tumors (RECIST 1.1) and Choi criteria. Needle electrodes with fixed linear (N-30-4B) or fixed hexagonal configurations (N-30-HG or I-40-HG or H-30-ST) or variable geometry (VGD1230 or VGD1240) (IGEA S.p.A., Carpi, Italy) were used to apply electric pulses. Pain evaluation was performed pre-ECT, after 1 month and after 6 months with ECT. Overall survival estimates were calculated by means of a Kaplan-Meier analysis. Results. At 1 month after ECT, 76% of patients were in partial response (PR) and 20% in stable disease (SD). Six months after ECT, 44.0% patients were still in PR and 12.0% in SD. A LDCR of 56.0% was reached six months after ECT: 13 patients treated with fixed geometry had a LDCR of 46.1%, while for the 12 patients treated with variable geometry, the LDCR was 66.7%. The overall survival median value was 11.5 months: for patients treated with fixed geometry the OS was 6 months, while for patients treated with variable geometry it was 12 months. Electrochemotherapy was well-tolerated and abdominal pain was rapidly resolved. Conclusions. Electrochemotherapy obtained good results in terms of LDCR and OS in LAPC. Multiple needle insertion in a variable geometry configuration optimized by pre-treatment planning determined an increase in LDCR and OS compared to a fixed geometry configuration.
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Granata V, Fusco R, Palaia R, Belli A, Petrillo A, Izzo F. Comments on "Electrochemotherapy with Irreversible Electroporation and FOLFIRINOX Improves Survival in Murine Models of Pancreatic Adenocarcinoma". Ann Surg Oncol 2020; 27:954-955. [PMID: 33011913 DOI: 10.1245/s10434-020-09183-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Vincenza Granata
- Istituto Nazionale Tumori IRCCS - Fondazione G Pascale, Naples, Italy
| | - Roberta Fusco
- Istituto Nazionale Tumori IRCCS - Fondazione G Pascale, Naples, Italy.
| | - Raffaele Palaia
- Istituto Nazionale Tumori IRCCS - Fondazione G Pascale, Naples, Italy
| | - Andrea Belli
- Istituto Nazionale Tumori IRCCS - Fondazione G Pascale, Naples, Italy
| | | | - Francesco Izzo
- Istituto Nazionale Tumori IRCCS - Fondazione G Pascale, Naples, Italy
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Merola G, Fusco R, Di Bernardo E, D’Alessio V, Izzo F, Granata V, Contartese D, Cadossi M, Audenino A, Perazzolo Gallo G. Design and Characterization of a Minimally Invasive Bipolar Electrode for Electroporation. BIOLOGY 2020; 9:biology9090303. [PMID: 32967343 PMCID: PMC7563710 DOI: 10.3390/biology9090303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To test a new bipolar electrode for electroporation consisting of a single minimally invasive needle. METHODS A theoretical study was performed by using Comsol Multiphysics® software. The prototypes of electrode have been tested on potatoes and pigs, adopting an irreversible electroporation protocol. Different applied voltages and different geometries of bipolar electrode prototype have been evaluated. RESULTS Simulations and pre-clinical tests have shown that the volume of ablated area is mainly influenced by applied voltage, while the diameter of the electrode had a lesser impact, making the goal of minimal-invasiveness possible. The conductive pole's length determined an increase of electroporated volume, while the insulated pole length inversely affects the electroporated volume size and shape; when the insulated pole length decreases, a more regular shape of the electric field is obtained. Moreover, the geometry of the electrode determined a different shape of the electroporated volume. A parenchymal damage in the liver of pigs due to irreversible electroporation protocol was observed. CONCLUSION The minimally invasive bipolar electrode is able to treat an electroporated volume of about 10 mm in diameter by using a single-needle electrode. Moreover, the geometry and the electric characteristics can be selected to produce ellipsoidal ablation volumes.
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Affiliation(s)
- Giulia Merola
- Oncology Medical and Research & Development Division, Igea SpA, 41012 Carpi, Italy; (G.M.); (E.D.B.); (V.D.); (M.C.); (G.P.G.)
| | - Roberta Fusco
- Oncology Medical and Research & Development Division, Igea SpA, 41012 Carpi, Italy; (G.M.); (E.D.B.); (V.D.); (M.C.); (G.P.G.)
- Correspondence:
| | - Elio Di Bernardo
- Oncology Medical and Research & Development Division, Igea SpA, 41012 Carpi, Italy; (G.M.); (E.D.B.); (V.D.); (M.C.); (G.P.G.)
| | - Valeria D’Alessio
- Oncology Medical and Research & Development Division, Igea SpA, 41012 Carpi, Italy; (G.M.); (E.D.B.); (V.D.); (M.C.); (G.P.G.)
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Unit, “Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli”, 80131 Naples, Italy;
| | - Vincenza Granata
- Radiology Unit, “Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli”, 80131 Naples, Italy;
| | - Deyanira Contartese
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Matteo Cadossi
- Oncology Medical and Research & Development Division, Igea SpA, 41012 Carpi, Italy; (G.M.); (E.D.B.); (V.D.); (M.C.); (G.P.G.)
| | - Alberto Audenino
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10138 Turin, Italy;
| | - Giacomo Perazzolo Gallo
- Oncology Medical and Research & Development Division, Igea SpA, 41012 Carpi, Italy; (G.M.); (E.D.B.); (V.D.); (M.C.); (G.P.G.)
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Liu Y, Li Y, Wang X, Huang Y, Zhang Q, Shi K, Ran C, Hou J, Wang X. Fufang Banmao Capsule, a Traditional Chinese Medicinal Formulation, Enhances the Survival of Patients with Hepatocellular Carcinoma and Vp3-4 Portal Vein Tumor Thrombosis Undergoing Supportive Treatment. J Altern Complement Med 2020; 26:956-965. [PMID: 32614605 DOI: 10.1089/acm.2019.0334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objectives: Fufang Banmao (FFBM) capsule, a type of Chinese medicinal formulation, has decades of history in treating hepatocellular carcinoma (HCC). This retrospective study aimed to observe the effect of FFBM capsules on the 6-month survival of patients with advanced HCC and Vp3-4 portal vein tumor thrombosis (PVTT) who received supportive therapy alone. Design: In total, 320 HCC/Vp3-4 PVTT patients underwent treatment with supportive therapy, of whom 95 took FFBM capsules and were treated with supportive therapy (FFBM group) and 225 received supportive therapy alone (control group). Comparisons of the 6-month overall survival (OS) rate of the two groups were performed. Propensity score matching (PSM) was used to match the characteristics between individuals in the two groups. A nomogram was built based on independent predictive factors for OS. Results: Cox multivariate analysis revealed that hepatic encephalopathy, aspartate transaminase (AST) and γ-glutamyl transpeptidase levels, Child-Pugh class, prothrombin time, α-fetoprotein level, largest tumor diameter, and use of FFBM capsules were independent predictive factors of OS. Variceal bleeding, alanine transaminase, AST, total bilirubin, and Barcelona Clinic for Liver Cancer stage were different at baseline in the FFBM and control groups. Analysis revealed no significant adverse effects or toxicities relevant to the medications. After PSM (1:1), 95 patient pairs were analyzed as FFBM versus control. The OS probability was remarkably higher for patients in the FFBM group than in those in the control group at 6 months (p < 0.0001). The median survival time was 4 months in the FFBM group and 2.2 months in the control group. Kaplan-Meier analysis showed significant statistical differences in the 6-month OS rates in the patients with total nomogram scores ≥84 (p < 0.0001). Conclusions: Given the satisfying survival outcomes, the results suggested that FFBM capsules should be administered to patients with HCC/Vp3-4 PVTT in the high-risk group (score ≥84). FFBM capsules have the potential for improving patient survival time in those with advanced HCC and Vp3-4 PVTT who receive supportive therapy alone, especially those in the high-risk group (score ≥84).
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Affiliation(s)
- Yao Liu
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuxin Li
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaojing Wang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yunyi Huang
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qun Zhang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ke Shi
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chongping Ran
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jie Hou
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xianbo Wang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Liu ZG, Chen XH, Yu ZJ, Lv J, Ren ZG. Recent progress in pulsed electric field ablation for liver cancer. World J Gastroenterol 2020; 26:3421-3431. [PMID: 32655266 PMCID: PMC7327785 DOI: 10.3748/wjg.v26.i24.3421] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/06/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
The number of liver cancer patients is likely to continue to increase in the coming decades due to the aging of the population and changing risk factors. Traditional treatments cannot meet the needs of all patients. New treatment methods evolved from pulsed electric field ablation are expected to lead to breakthroughs in the treatment of liver cancer. This paper reviews the safety and efficacy of irreversible electroporation in clinical studies, the methods to detect and evaluate its ablation effect, the improvements in equipment and its antitumor effect, and animal and clinical trials on electrochemotherapy. We also summarize studies on the most novel nanosecond pulsed electric field ablation techniques in vitro and in vivo. These research results are certain to promote the progress of pulsed electric field in the treatment of liver cancer.
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Affiliation(s)
- Zhen-Guo Liu
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
- Gene Hospital of Henan Province, Zhengzhou 450052, Henan Province, China
- Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Xin-Hua Chen
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou 310003, Zhejiang Province, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
| | - Zu-Jiang Yu
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
- Gene Hospital of Henan Province, Zhengzhou 450052, Henan Province, China
- Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Jun Lv
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
- Gene Hospital of Henan Province, Zhengzhou 450052, Henan Province, China
- Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Zhi-Gang Ren
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
- Gene Hospital of Henan Province, Zhengzhou 450052, Henan Province, China
- Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
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Percutaneous image guided electrochemotherapy of hepatocellular carcinoma: technological advancement. Radiol Oncol 2020; 54:347-352. [PMID: 32562533 PMCID: PMC7409604 DOI: 10.2478/raon-2020-0038] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/01/2020] [Indexed: 12/17/2022] Open
Abstract
Background Electrochemotherapy is an effective treatment of colorectal liver metastases and hepatocellular carcinoma (HCC) during open surgery. The minimally invasive percutaneous approach of electrochemotherapy has already been performed but not on HCC. The aim of this study was to demonstrate the feasibility, safety and effectiveness of electrochemotherapy with percutaneous approach on HCC. Patient and methods The patient had undergone the transarterial chemoembolization and microwave ablation of multifocal HCC in segments III, V and VI. In follow-up a new lesion was identified in segment III, and recognized by multidisciplinary team to be suitable for minimally invasive percutaneous electrochemotherapy. The treatment was performed with long needle electrodes inserted by the aid of image guidance. Results The insertion of electrodes was feasible, and the treatment proved safe and effective, as demonstrated by control magnetic resonance imaging. Conclusions Minimally invasive, image guided percutaneous electrochemotherapy is feasible, safe and effective in treatment of HCC.
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Intraoperative electrochemotherapy of colorectal liver metastases: A prospective phase II study. Eur J Surg Oncol 2020; 46:1628-1633. [PMID: 32387070 DOI: 10.1016/j.ejso.2020.04.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/20/2020] [Accepted: 04/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A previous pilot study proved the feasibility, safety and efficacy of electrochemotherapy in the treatment of colorectal liver metastases. The aim of this study was to evaluate long-term effectiveness and safety of electrochemotherapy in the treatment of unresectable colorectal liver metastases. PATIENTS AND METHODS In this prospective phase II study, patients with metachronous colorectal liver metastases were included. In all patients, at least one metastasis was unresectable due to its central location or a too-small future remnant liver volume. Patients were treated by electrochemotherapy using intravenously administered bleomycin during open surgery. Treated were 84 metastases in 39 patients. Local tumor control, progression-free survival and overall survival were evaluated. RESULTS The objective response was 75% (63% CR, 12% PR). The median duration of the response was 20.8 months for metastases in CR and 9.8 months for metastases in PR. The therapy was significantly more effective for metastases smaller than 3 cm in diameter than for larger ones. There was no difference in response according to the metastatic location, i.e., metastases in central vs. peripheral locations. Progression-free survival was better in patients who responded well to electrochemotherapy compared to those metastases that had a partial response or progressive disease. However, there was no difference in overall survival, with a median of 29.0 months. CONCLUSIONS Electrochemotherapy has proven to be safe and effective in the treatment of colorectal liver metastases, with a durable response. It provides local tumor control that enables patients with unresectable metastases to receive further treatments.
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Izzo F, Ionna F, Granata V, Albino V, Patrone R, Longo F, Guida A, Delrio P, Rega D, Scala D, Pezzuto R, Fusco R, Di Bernardo E, D’Alessio V, Grassi R, Contartese D, Palaia R. New Deployable Expandable Electrodes in the Electroporation Treatment in a Pig Model: A Feasibility and Usability Preliminary Study. Cancers (Basel) 2020; 12:cancers12020515. [PMID: 32102182 PMCID: PMC7072261 DOI: 10.3390/cancers12020515] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 02/07/2023] Open
Abstract
The aim of the study is to evaluate the usability aspects of new deployable, expandable, electrode prototypes, in terms of suitability solutions for laparoscopic applications on the liver, endoscopic trans-oral and trans-anal procedures, electroporation segmentation in several steps, mechanical functionality (flexibility, penetrability), visibility of the electrode under instrumental guidance, compatibility of the electrode with laparoscopic/endoscopic accesses, surgical instruments, and procedural room and safety compatibility. The electroporation was performed on an animal model (Sus Scrofa Large White 60 kg) both in laparoscopy and endoscopy, under ultrasound guidance, and in open surgery. Electrodes without divergence, with needles coming out straight, parallel to each other, and electrodes with peripheral needles (four needles), diverging from the electrode shaft axis (electrode with non-zero divergence) have been tested. To cause an evaluable necrosis effect, the number of electrical pulses was increased to induce immediate liver cell death. Histological samples were analyzed by staining with Haematoxylin/Eosin or by immunohistochemical staining to confirm complete necrosis. The prototypes of expandable electrodes, tested in laparoscopy and endoscopy and in open surgery, respectively, are suitable in terms of usability, electroporation segmentation in several steps, mechanical functionality (flexibility, penetrability), visibility under instrumental guidance, compatibility with laparoscopic/endoscopic accesses, surgical instruments and procedural room safety, patient safety (no bleeding and/or perforation), and treatment efficacy (adequate ablated volume). Electroporation treatment using new deployable expandable electrode prototypes is safe and feasible. Moreover, electrode configurations allow for a gradual increase in the ablated area in consecutive steps, as confirmed by histology and immunohistochemistry.
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Affiliation(s)
- Francesco Izzo
- Division of Surgical Oncology, Hepatobiliary Unit, ISTITUTO NAZIONALE TUMORI–IRCCS-FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Via Mariano Semmola, 80131 Naples, Italy; (V.A.); (R.P.)
- Correspondence:
| | - Franco Ionna
- Division of Surgical Oncology, Maxillo-Facial Unit, ISTITUTO NAZIONALE TUMORI–IRCCS-FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Via Mariano Semmola, 80131 Naples, Italy; (F.I.); (F.L.); (A.G.)
| | - Vincenza Granata
- Division of Radiodiagnostic, ISTITUTO NAZIONALE TUMORI–IRCCS-FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Via Mariano Semmola, 80131 Naples, Italy;
| | - Vittorio Albino
- Division of Surgical Oncology, Hepatobiliary Unit, ISTITUTO NAZIONALE TUMORI–IRCCS-FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Via Mariano Semmola, 80131 Naples, Italy; (V.A.); (R.P.)
| | - Renato Patrone
- Division of General and Oncologic Surgery, Department of Cardiothoracic Sciences, UNIVERSITA’ DEGLI STUDI DELLA CAMPANIA LUIGI VANVITELLI, NAPOLI, ITALIA, 80131 Naples, Italy;
| | - Francesco Longo
- Division of Surgical Oncology, Maxillo-Facial Unit, ISTITUTO NAZIONALE TUMORI–IRCCS-FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Via Mariano Semmola, 80131 Naples, Italy; (F.I.); (F.L.); (A.G.)
| | - Agostino Guida
- Division of Surgical Oncology, Maxillo-Facial Unit, ISTITUTO NAZIONALE TUMORI–IRCCS-FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Via Mariano Semmola, 80131 Naples, Italy; (F.I.); (F.L.); (A.G.)
| | - Paolo Delrio
- Division of Surgical Oncology, Colo-Rectal Unit, ISTITUTO NAZIONALE TUMORI–IRCCS-FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Via Mariano Semmola, 80131 Naples, Italy; (P.D.); (D.R.); (D.S.); (R.P.)
| | - Daniela Rega
- Division of Surgical Oncology, Colo-Rectal Unit, ISTITUTO NAZIONALE TUMORI–IRCCS-FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Via Mariano Semmola, 80131 Naples, Italy; (P.D.); (D.R.); (D.S.); (R.P.)
| | - Dario Scala
- Division of Surgical Oncology, Colo-Rectal Unit, ISTITUTO NAZIONALE TUMORI–IRCCS-FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Via Mariano Semmola, 80131 Naples, Italy; (P.D.); (D.R.); (D.S.); (R.P.)
| | - Roberto Pezzuto
- Division of Surgical Oncology, Colo-Rectal Unit, ISTITUTO NAZIONALE TUMORI–IRCCS-FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Via Mariano Semmola, 80131 Naples, Italy; (P.D.); (D.R.); (D.S.); (R.P.)
| | - Roberta Fusco
- Research & Development Division, Igea SpA, Via Casarea 65, Casalnuovo di Napoli, 80013 Naples, Italy; (R.F.); (E.D.B.); (V.D.)
| | - Elio Di Bernardo
- Research & Development Division, Igea SpA, Via Casarea 65, Casalnuovo di Napoli, 80013 Naples, Italy; (R.F.); (E.D.B.); (V.D.)
| | - Valeria D’Alessio
- Research & Development Division, Igea SpA, Via Casarea 65, Casalnuovo di Napoli, 80013 Naples, Italy; (R.F.); (E.D.B.); (V.D.)
| | - Roberto Grassi
- Division of Radiodiagnostic, UNIVERSITA’ DEGLI STUDI DELLA CAMPANIA LUIGI VANVITELLI, NAPOLI, ITALIA, Via Miraglia, 80143 Naples, Italy;
| | - Deyanira Contartese
- Laboratory Preclinical and Surgical Studies, IRCCS–ISTITUTO ORTOPEDICO RIZZOLI, Via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Raffaele Palaia
- Division of Surgical Oncology, Hepatobiliary Unit, ISTITUTO NAZIONALE TUMORI–IRCCS-FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Via Mariano Semmola, 80131 Naples, Italy; (V.A.); (R.P.)
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Radiological findings of porcine liver after electrochemotherapy with bleomycin. Radiol Oncol 2019; 53:415-426. [PMID: 31600140 PMCID: PMC6884938 DOI: 10.2478/raon-2019-0049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/12/2019] [Indexed: 12/11/2022] Open
Abstract
Background Radiologic findings after electrochemotherapy of large hepatic blood vessels and healthy hepatic parenchyma have not yet been described. Materials and methods We performed a prospective animal model study with regulatory approval, including nine grower pigs. In each animal, four ultrasound-guided electroporated regions were created; in three regions, electrodes were inserted into the lumen of large hepatic vessels. Two types of electrodes were tested; variable linear- and fixed hexagonal-geometry electrodes. Ultrasonographic examinations were performed immediately and up to 20 minutes after the procedure. Dynamic computed tomography was performed before and at 60 to 90 minutes and one week after the procedure. Results Radiologic examinations of the treated areas showed intact vessel walls and patency; no hemorrhage or thrombi were noted. Ultrasonographic findings were dynamic and evolved from hyperechogenic microbubbles along electrode tracks to hypoechogenicity of treated parenchyma, diffusion of hyperechogenic microbubbles, and hypoechogenicity fading. Contrast-enhanced ultrasound showed decreased perfusion of the treated area. Dynamic computed tomography at 60 to 90 minutes after the procedure showed hypoenhancing areas. The total hypoenhancing area was smaller after treatment with fixed hexagonal electrodes than after treatment with variable linear geometry electrodes. Conclusions Radiologic findings of porcine liver after electrochemotherapy with bleomycin did not show clinically significant damage to the liver, even if a hazardous treatment strategy, such as large vessel intraluminal electrode insertion, was employed, and thus further support safety and clinical use of electrochemotherapy for treatment of hepatic neoplasia.
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Cerrito L, Annicchiarico BE, Iezzi R, Gasbarrini A, Pompili M, Ponziani FR. Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: Beyond the known frontiers. World J Gastroenterol 2019; 25:4360-4382. [PMID: 31496618 PMCID: PMC6710186 DOI: 10.3748/wjg.v25.i31.4360] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/24/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma is one of the most frequent malignant tumors worldwide: Portal vein tumor thrombosis (PVTT) occurs in about 35%-50% of patients and represents a strong negative prognostic factor, due to the increased risk of tumor spread into the bloodstream, leading to a high recurrence risk. For this reason, it is a contraindication to liver transplantation and in several prognostic scores sorafenib represents its standard of care, due to its antiangiogenetic action, although it can grant only a poor prolongation of life expectancy. Recent scientific evidences lead to consider PVTT as a complex anatomical and clinical condition, including a wide range of patients with different prognosis and new treatment possibilities according to the degree of portal system involvement, tumor biological aggressiveness, complications caused by portal hypertension, patient's clinical features and tolerance to antineoplastic treatments. The median survival has been reported to range between 2.7 and 4 mo in absence of therapy, but it can vary from 5 mo to 5 years, thus depicting an extremely variable scenario. For this reason, it is extremely important to focus on the most adequate strategy to be applied to each group of PVTT patients.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Hepatocellular/complications
- Carcinoma, Hepatocellular/mortality
- Carcinoma, Hepatocellular/therapy
- Chemoembolization, Therapeutic/methods
- Contrast Media/administration & dosage
- Disease-Free Survival
- Hepatectomy
- Humans
- Hypertension, Portal/etiology
- Hypertension, Portal/mortality
- Hypertension, Portal/therapy
- Liver Neoplasms/complications
- Liver Neoplasms/mortality
- Liver Neoplasms/therapy
- Liver Transplantation
- Neoadjuvant Therapy/methods
- Neoplasm Invasiveness/pathology
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/prevention & control
- Patient Selection
- Portal Vein/diagnostic imaging
- Portal Vein/pathology
- Prognosis
- Survival Analysis
- Thrombectomy
- Time Factors
- Ultrasonography/methods
- Venous Thrombosis/etiology
- Venous Thrombosis/mortality
- Venous Thrombosis/therapy
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Affiliation(s)
- Lucia Cerrito
- Division of Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Brigida Eleonora Annicchiarico
- Division of Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Roberto Iezzi
- Department of Bioimaging and Radiological Sciences, Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Antonio Gasbarrini
- Division of Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maurizio Pompili
- Division of Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Francesca Romana Ponziani
- Division of Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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Single-needle electroporation and interstitial electrochemotherapy: in vivo safety and efficacy evaluation of a new system. Eur Radiol 2019; 29:6300-6308. [DOI: 10.1007/s00330-019-06251-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/12/2019] [Accepted: 04/24/2019] [Indexed: 12/18/2022]
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Irreversible electroporation for hepatic tumors. J Ultrasound 2019; 22:1-3. [PMID: 30840216 DOI: 10.1007/s40477-019-00367-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/21/2019] [Indexed: 01/04/2023] Open
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Granata V, Fusco R, Setola SV, Palaia R, Albino V, Piccirillo M, Grimm R, Petrillo A, Izzo F. Diffusion kurtosis imaging and conventional diffusion weighted imaging to assess electrochemotherapy response in locally advanced pancreatic cancer. Radiol Oncol 2019; 53:15-24. [PMID: 30681974 PMCID: PMC6411027 DOI: 10.2478/raon-2019-0004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/18/2018] [Indexed: 02/06/2023] Open
Abstract
Background The aim of the study was to evaluate diagnostic performance of functional parameters derived by conventional mono-exponential approach of diffusion weighted imaging (DWI) and by diffusion kurtosis imaging (DKI) in the assessment of pancreatic tumours treated with electrochemotherapy (ECT). Patients and methods Twenty-one consecutive patients with locally advanced pancreatic adenocarcinoma subjected to ECT were enrolled in a clinical approved trial. Among twenty-one enrolled patients, 13/21 (61.9%) patients were subjected to MRI before and after ECT. DWI was performed with a 1.5 T scanner; a free breathing axial single shot echo planar DWI pulse sequence parameters were acquired using seven b value = 0, 50, 100, 150, 400, 800, 1000 s/mm2. Apparent diffusion coefficient by conventional mono-exponential approach and mean of diffusion coefficient (MD) and mean of diffusional kurtosis (MK) by DKI approach were derived from DWI. Receiver operating characteristic (ROC) analysis was performed and sensitivity, specificity, positive and negative predictive value were calculated. Results Among investigated diffusion parameters, only the MD derived by DKI showed a significant variation of values between pre and post treatment (p = 0.02 at Wilcoxon test) and a significant statistically difference for percentage change between responders and not responders (p = 0.01 at Kruskal Wallis test). MD had a good diagnostic performance with a sensitivity of 80%, a specificity of 100% and area under ROC of 0.933. Conclusions MD derived by DKI allows identifying responders and not responders patients subject to ECT treatment. MD had higher diagnostic performance to assess ECT response compared to conventional DWI derived parameters.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, Instituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Napoli, Italia
- Vincenza Granata, Division of Radiology, Instituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Napoli, Italia. Phone: +39 081 5903 714; Fax:+39 0815903825;
| | | | - Sergio Venanzio Setola
- Division of Radiology, Instituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Napoli, Italia
| | - Raffaele Palaia
- Division of Hepatobiliary Surgical Oncology, Unit, Instituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Vittorio Albino
- Division of Hepatobiliary Surgical Oncology, Unit, Instituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | - Mauro Piccirillo
- Division of Hepatobiliary Surgical Oncology, Unit, Instituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
| | | | - Antonella Petrillo
- Division of Radiology, Instituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Napoli, Italia
| | - Francesco Izzo
- Division of Hepatobiliary Surgical Oncology, Unit, Instituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italia
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Chen Y, Moser MAJ, Luo Y, Zhang W, Zhang B. Chemical Enhancement of Irreversible Electroporation: A Review and Future Suggestions. Technol Cancer Res Treat 2019; 18:1533033819874128. [PMID: 31500518 PMCID: PMC6737874 DOI: 10.1177/1533033819874128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/20/2019] [Accepted: 08/01/2019] [Indexed: 12/18/2022] Open
Abstract
Irreversible electroporation has raised great interest in the past decade as a means of destroying cancers in a way that does not involve heat. Irreversible electroporation is a novel ablation technology that uses short high-voltage electrical pulses to enhance the permeability of tumor cell membranes and generate irreversible nano-sized structural defects or pores, thus leading to cell death. Irreversible electroporation has many advantages over thermal therapies due to its nonthermal mechanism: (1) reduced risk of injury to surrounding organs and (2) no "heat-sink" effect due to nearby blood vessels. However, so far, it has been difficult for irreversible electroporation to completely ablate large tumors (eg, >3 cm in diameter). In order to overcome this problem, many preclinical and clinical studies have been performed to improve the efficacy of IRE in the treatment of large size of tumors through a chemical perspective. Due to the distribution of electric field, irreversible electroporation region, reversible electroporation region, and intact region can be found in the treatment of irreversible electroporation. Thus, 2 types of chemical enhancements of irreversible electroporation were discussed in the article, such as the reversible electroporation region enhanced and the irreversible electroporation region enhanced. Specifically, the state-of-the-art results regarding the following approaches that have the potential to be used in the enhancement of irreversible electroporation were systematically reviewed in the article, including (1) combination with cytotoxic drugs, (2) calcium electroporation, (3) modification of cell membrane, and (4) modification of the tumor cell microenvironment. In the end, we concluded with 4 issues that should be addressed in the future for improving irreversible electroporation further in a chemical way.
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Affiliation(s)
- Ying Chen
- School of Mechanical and Power Engineering, East China University of Science and Technology, Shanghai, China
| | | | - Yigang Luo
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Wenjun Zhang
- School of Mechanical and Power Engineering, East China University of Science and Technology, Shanghai, China
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, Canada
| | - Bing Zhang
- Energy-based Tumor Ablation Laboratory, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
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Campana LG, Edhemovic I, Soden D, Perrone AM, Scarpa M, Campanacci L, Cemazar M, Valpione S, Miklavčič D, Mocellin S, Sieni E, Sersa G. Electrochemotherapy - Emerging applications technical advances, new indications, combined approaches, and multi-institutional collaboration. Eur J Surg Oncol 2018; 45:92-102. [PMID: 30528893 DOI: 10.1016/j.ejso.2018.11.023] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/30/2018] [Indexed: 12/18/2022] Open
Abstract
The treatment of tumors with electrochemotherapy (ECT) has surged over the past decade. Thanks to the transient cell membrane permeabilization induced by the short electric pulses used by ECT, cancer cells are exposed to otherwise poorly permeant chemotherapy agents, with consequent increased cytotoxicity. The codification of the procedure in 2006 led to a broad diffusion of the procedure, mainly in Europe, and since then, the progressive clinical experience, together with the emerging technologies, have extended the range of its application. Herein, we review the key advances in the ECT field since the European Standard Operating Procedures on ECT (ESOPE) 2006 guidelines and discuss the emerging clinical data on the new ECT indications. First, technical developments have improved ECT equipment, with custom electrode probes and dedicated tools supporting individual treatment planning in anatomically challenging tumors. Second, the feasibility and short-term efficacy of ECT has been established in deep-seated tumors, including bone metastases, liver malignancies, and pancreatic and prostate cancers (long-needle variable electrode geometry ECT), and gastrointestinal tumors (endoscopic ECT). Moreover, pioneering studies indicate lung and brain tumors as suitable future targets. A further advance relates to new combination strategies with immunotherapy, gene electro transfer (GET), calcium EP, and radiotherapy. Finally and fourth, cross-institutional collaborative groups have been established to refine procedural guidelines, promote clinical research, and explore new indications.
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Affiliation(s)
- Luca G Campana
- Department of Surgery Oncology and Gastroenterology (DISCOG), University of Padua, Italy; Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
| | - Ibrahim Edhemovic
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Anna M Perrone
- Oncologic Gynecology Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Marco Scarpa
- Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Laura Campanacci
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Sara Valpione
- Christie NHS Foundation Trust, CRUK Manchester Institute, The University of Manchester, Manchester, M20 4GJ, UK
| | - Damijan Miklavčič
- University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia
| | - Simone Mocellin
- Department of Surgery Oncology and Gastroenterology (DISCOG), University of Padua, Italy; Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Elisabetta Sieni
- Department of Industrial Engineering, University of Padua, Italy
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Tarantino L, Busto G, Nasto A, Nasto RA, Tarantino P, Fristachi R, Cacace L, Bortone S. Electrochemotherapy of cholangiocellular carcinoma at hepatic hilum: A feasibility study. Eur J Surg Oncol 2018; 44:1603-1609. [PMID: 30017329 DOI: 10.1016/j.ejso.2018.06.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023] Open
Abstract
AIM We evaluated feasibility, safety and efficacy of Electrochemotherapy (ECT) in a prospective series of patients with unresectable Perihilar-Cholangiocarcinoma (PHCCA). PATIENTS AND METHODS Five patients with PHCCA underwent ECT. Three patients underwent percutaneous ECT of a single PHCCA nodule. One patient underwent resection of a nodule in the IV segment and intraoperative ECT of a large PHCCA in the VIII segment. Another patient underwent percutaneous ECT of a large PHCCA recurrence after left lobectomy and RF ablation of a synchronous metastasis in the VI segment. ECT was performed under US guidance. Efficacy was evaluated by contrast-enhanced multiple-detector-computed-tomography (MDCT) 4 weeks after treatment. Follow-up entailed MDCT every 6 months thereafter. RESULTS No major complication occurred. Follow-up ranges from 10 to 30 months. Four weeks post-treatment CT showed complete response in 3 cases. These patients are still alive, and follow-up CT controls demonstrated no local or distant intrahepatic recurrences and no biliary duct dilation in 2 cases and local recurrence at 18 months follow-up control in 1 patient. In the remaining 2 cases, 4-weeks-post-treatment CT showed incomplete response (>90%). In these patients follow-up CT demonstrated local progression of the disease at 6 months. One of them had bilateral external biliary drainages and died because of tumor progression at 16-months-follow-up. The other patient, died at 10 months follow-up for cardiovascular failure not related to the hepatobiliary disease. CONCLUSIONS ECT is feasible, safe and effective therapy to improve prognosis and quality of life of patients with unresectable PHCCA.
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Affiliation(s)
| | | | | | | | | | | | | | - Sara Bortone
- Radiology-A.Tortora Cancer Hospital, Pagani, Italy
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41
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Djokic M, Cemazar M, Popovic P, Kos B, Dezman R, Bosnjak M, Zakelj MN, Miklavcic D, Potrc S, Stabuc B, Tomazic A, Sersa G, Trotovsek B. Electrochemotherapy as treatment option for hepatocellular carcinoma, a prospective pilot study. Eur J Surg Oncol 2018; 44:651-657. [PMID: 29402556 DOI: 10.1016/j.ejso.2018.01.090] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/21/2017] [Accepted: 01/16/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Electrochemotherapy provides non-thermal ablation of cutaneous as well as deep seated tumors. Based on positive results of the treatment of colorectal liver metastases, we conducted a prospective pilot study on hepatocellular carcinomas with the aim of testing the feasibility, safety and effectiveness of electrochemotherapy. PATIENTS AND METHODS Electrochemotherapy with bleomycin was performed on 17 hepatocellular carcinomas in 10 patients using a previously established protocol. The procedure was performed during open surgery and the patients were followed for median 20.5 months. RESULTS Electrochemotherapy was feasible for all 17 lesions, and no treatment-related adverse events or major post-operative complications were observed. The median size of the treated lesions was 24 mm (range 8-41 mm), located either centrally, i.e., near the major hepatic vessels, or peripherally. The complete response rate at 3-6 months was 80% per patient and 88% per treated lesion. CONCLUSIONS Electrochemotherapy of hepatocellular carcinoma proved to be a feasible and safe treatment in all 10 patients included in this study. To evaluate the effectiveness of this method, longer observation period is needed; however the results at medium observation time of 20.5 months after treatment are encouraging, in 15 out of 17 lesions complete response was obtained. Electrochemotherapy is predominantly applicable in patients with impaired liver function due to liver cirrhosis and/or with lesions where a high-risk operation is needed to achieve curative intent, given the intra/perioperative risk for high morbidity and mortality.
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Affiliation(s)
- Mihajlo Djokic
- University Medical Centre Ljubljana, Department of Abdominal Surgery, Zaloska 7, SI-1000 Ljubljana, Slovenia
| | - Maja Cemazar
- Institute of Oncology Ljubljana, Department of Experimental Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia; University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia
| | - Peter Popovic
- University Medical Centre Ljubljana, Institute of Radiology, Zaloska 7, SI-1000 Ljubljana, Slovenia
| | - Bor Kos
- University of Ljubljana, Faculty of Electrical Engineering, Trzaska 25, Ljubljana SI-1000, Slovenia
| | - Rok Dezman
- University Medical Centre Ljubljana, Institute of Radiology, Zaloska 7, SI-1000 Ljubljana, Slovenia
| | - Masa Bosnjak
- Institute of Oncology Ljubljana, Department of Experimental Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia
| | - Martina Niksic Zakelj
- Institute of Oncology Ljubljana, Department of Experimental Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia
| | - Damijan Miklavcic
- University of Ljubljana, Faculty of Electrical Engineering, Trzaska 25, Ljubljana SI-1000, Slovenia
| | - Stojan Potrc
- University Clinical Centre Maribor, Department of Abdominal Surgery, Ljubljanska ulica 5, SI-2000 Maribor, Slovenia
| | - Borut Stabuc
- University Medical Centre Ljubljana, Department of Gastroenterology, Zaloska 7, SI-1000 Ljubljana, Slovenia
| | - Ales Tomazic
- University Medical Centre Ljubljana, Department of Abdominal Surgery, Zaloska 7, SI-1000 Ljubljana, Slovenia
| | - Gregor Sersa
- Institute of Oncology Ljubljana, Department of Experimental Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia; University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, SI-1000 Ljubljana, Slovenia.
| | - Blaz Trotovsek
- University Medical Centre Ljubljana, Department of Abdominal Surgery, Zaloska 7, SI-1000 Ljubljana, Slovenia.
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42
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Zhao D, Wu M, Huang D, Liang Z, Wei Z, Li Z. Parametric optimization of electric field strength for cancer electrochemotherapy on a chip-based model. Theranostics 2018; 8:358-368. [PMID: 29290813 PMCID: PMC5743553 DOI: 10.7150/thno.21099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/08/2017] [Indexed: 12/21/2022] Open
Abstract
Electrochemotherapy (ECT), as one of the very few available treatments for cutaneous and subcutaneous tumors when surgery and radiotherapy are no longer available, requires applying a proper electric field to the tumor to realize electroporation-mediated cytotoxic drug delivery. It is impossible to exhaust all possible electrical parameters on patients to realize the optimal tradeoff between tumor suppression and adverse effects. To address this issue, this study provides a feasible solution by developing a four-leaf micro-electrode chip (F-MEC) in which the electric field was specially designed by linear distribution to cover all possible electric field strengths for ECT. Methods: We developed a F-MEC that provides a linearly varied electric field and a capacity for in situ observation of cell status. By culturing tumor cells on the F-MEC surface and in situ monitoring the cell responses to ECT drugs, the optimal electric field strength for any given cell type could be rapidly and accurately calculated in a few, or even only one, simple assay. Results: Using this chip, we monitored MCF-7 and A315 cell responses to ECT and determined the optimum ECT voltage. More importantly, we successfully verified that the in vitro determined voltage coincided with the optimal value for in vivo ECT in mice. Conclusion: In this proof-of-concept study, the in vivo tumor suppression assays proved that the optimal parameters acquired from in vitro F-MEC assay could be used for in vivo ECT.
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43
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Probst U, Fuhrmann I, Beyer L, Wiggermann P. Electrochemotherapy as a New Modality in Interventional Oncology: A Review. Technol Cancer Res Treat 2018; 17:1533033818785329. [PMID: 29986632 PMCID: PMC6048674 DOI: 10.1177/1533033818785329] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/01/2018] [Accepted: 05/24/2018] [Indexed: 12/18/2022] Open
Abstract
Electroporation is a well-known phenomenon that occurs at the cell membrane when cells are exposed to high-intensity electric pulses. Depending on electric pulse amplitude and number of pulses, applied electroporation can be reversible with membrane permeability recovery or irreversible. Reversible electroporation is used to introduce drugs or genetic material into the cell without affecting cell viability. Electrochemotherapy refers to a combined treatment: electroporation and drug injection to enhance its cytotoxic effect up to 1000-fold for bleomycin. Since several years, electrochemotherapy is gaining popularity as minimally invasive oncologic treatment. The adoption of electrochemotherapy procedure in interventional oncology poses several unsolved questions, since suitable tumor histology and size as well as therapeutic efficacy still needs to be deepen. Electrochemotherapy is usually applied in palliative settings for the treatment of patients with unresectable tumors to relieve pain and ameliorate quality of life. In most cases, it is used in the treatment of advanced stages of neoplasia when radical surgical treatment is not possible (eg, due to lesion location, size, and/or number). Further, electrochemotherapy allows treating tumor nodules in the proximity of important structures like vessels and nerves as the treatment does not involve tissue heating. Overall, the safety profile of electrochemotherapy is favorable. Most of the observed adverse events are local and transient, moderate local pain, erythema, edema, and muscle contractions during electroporation. The aim of this article is to review the recent published clinical experiences of electrochemotherapy use in deep-seated tumors with particular focus on liver cases. The principle of electrochemotherapy as well as the application to cutaneous metastases is briefly described. A short insight in the treatment of bone metastases, unresectable pancreas cancer, and soft tissue sarcoma will be given. Preclinical and clinical studies on treatment efficacy with electrochemotherapy of hepatic lesions and safety of the procedure adopted are discussed.
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Affiliation(s)
- Ute Probst
- Universitätsklinikum Regensburg Institut für Röntgendiagnostik, Regensburg,
Germany
| | - Irene Fuhrmann
- Universitätsklinikum Regensburg Institut für Röntgendiagnostik, Regensburg,
Germany
| | - Lukas Beyer
- Städtisches Klinikum Braunschweig, Institut für Röntgendiagnostik und
Nuklearmedizin, Braunschweig, Germany
| | - Philipp Wiggermann
- Universitätsklinikum Regensburg Institut für Röntgendiagnostik, Regensburg,
Germany
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44
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Predicting irreversible electroporation-induced tissue damage by means of magnetic resonance electrical impedance tomography. Sci Rep 2017; 7:10323. [PMID: 28871138 PMCID: PMC5583379 DOI: 10.1038/s41598-017-10846-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/15/2017] [Indexed: 02/07/2023] Open
Abstract
Irreversible electroporation (IRE) is gaining importance in routine clinical practice for nonthermal ablation of solid tumors. For its success, it is extremely important that the coverage and exposure time of the treated tumor to the electric field is within the specified range. Measurement of electric field distribution during the electroporation treatment can be achieved using magnetic resonance electrical impedance tomography (MREIT). Here, we show improved MREIT-enabled electroporation monitoring of IRE-treated tumors by predicting IRE-ablated tumor areas during IRE of mouse tumors in vivo. The in situ prediction is enabled by coupling MREIT with a corresponding Peleg-Fermi mathematical model to obtain more informative monitoring of IRE tissue ablation by providing cell death probability in the IRE-treated tumors. This technique can potentially be used in electroporation-based clinical applications, such as IRE tissue ablation and electrochemotherapy, to improve and assure the desired treatment outcome.
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45
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Granata V, Fusco R, Setola SV, Piccirillo M, Leongito M, Palaia R, Granata F, Lastoria S, Izzo F, Petrillo A. Early radiological assessment of locally advanced pancreatic cancer treated with electrochemotherapy. World J Gastroenterol 2017; 23:4767-4778. [PMID: 28765698 PMCID: PMC5514642 DOI: 10.3748/wjg.v23.i26.4767] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/01/2017] [Accepted: 05/04/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To report early imaging assessment of ablated area post electrochemotherapy (ECT) in patients with locally advanced pancreatic cancer (LAPC).
METHODS ECT was performed in 19 LAPC patients enrolled in an approved ongoing clinical phase I/II study. Before and after ECT, 18 patients underwent computed tomography (CT) scan, 11 patients underwent morphological and functional magnetic resonance (MR) scan (dynamic contrast enhanced-MRI) calculating wash-in slope (WIS) and wash-out slope (WOS); diffusion weighted imaging calculating pseudo-diffusivity (Dp), perfusion fraction (fp) and tissue diffusivity (Dt); 10 patients underwent positron emission tomography (PET). Response evaluation criteria in solid tumour (RECIST) on MR and CT were used to assess tumour therapy response. Choi on CT, PET response criteria in solid tumors (PERCIST) on PET and functional parameters on MR were used to evaluate treatment response.
RESULTS For each patient no significant reduction was measurable by CT and MR using RECIST. According Choi criteria a partial response was obtained in 18/18 (100.0%) patients. According PERCIST criteria 6/10 (60.0%) patients showed a partial response, 3/10 (30.0%) stable disease and 1/10 (10.0%) progression disease. Moreover, using functional MR parameters, a significant reduction of viable tumour after ECT can be observed. According ΔWIS and ΔWOS 9/11 (81.8%) patients exhibited a partial response and 2/11 (18.2%) stable disease; 8/11 (72.7%) patients were considered in partial response by ΔDp evaluation and 3/11 (27.3%) in stable disease; according ΔDt 7/11 (63.6%) patients showed a partial response, 1/11 (9.1%) showed progression of disease and 3/11 (27.3%) were stable. Perfusion fraction fp showed a significant reduction after ECT only in four patients. No significant difference was observed after ECT in signal intensity of T1-weighted images and T2-weighted images, and in equilibrium-phase of contrast study, according to χ2 test was observed. A good correlation was reported between ΔHounsfield unit and Δmaximum standardized uptake value and between Δfp and ΔWOS, with a significant statistically difference (P < 0.05) using Spearman correlation coefficient.
CONCLUSION Perfusion and diffusion MR derived parameters, Choi, PERCIST criteria are more performant than morphological MR and CT criteria to assess ECT treatment response.
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