Irreversible Electroporation Can Effectively Ablate Hepatocellular Carcinoma to Complete Pathologic Necrosis

Cheng, Richard; Bhattacharya, Renuka; Yeh, Matthew M.; Padia, Siddharth A.

doi:10.1016/j.jvir.2015.05.014

Cited by 54 publications

(48 citation statements)

References 17 publications

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“…Therefore it could be expected that this accounts for human liver tissue treated with IRE as well, and tumorous tissue could even be replaced with fibrotic tissue or resolve completely after this time[31, 34]. However, Cheng and colleagues performed a resection following IRE with a median of 10 months (range 3–17 months) after ablation on liver in patients diagnosed with hepatocellular carcinoma[54]. Tumors treated with IRE showed sharp demarcated zones of confluent necrosis at this time of evaluation, rather than fibrosis or pathologically normal tissue.…”

Section: Discussionmentioning

confidence: 99%

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Time-Dependent Impact of Irreversible Electroporation on Pancreas, Liver, Blood Vessels and Nerves: A Systematic Review of Experimental Studies

et al. 2016

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IntroductionIrreversible electroporation (IRE) is a novel ablation technique in the treatment of unresectable cancer. The non-thermal mechanism is thought to cause mostly apoptosis compared to necrosis in thermal techniques. Both in experimental and clinical studies, a waiting time between ablation and tissue or imaging analysis to allow for cell death through apoptosis, is often reported. However, the dynamics of the IRE effect over time remain unknown. Therefore, this study aims to summarize these effects in relation to the time between treatment and evaluation.MethodsA systematic search was performed in Pubmed, Embase and the Cochrane Library for original articles using IRE on pancreas, liver or surrounding structures in animal or human studies. Data on pathology and time between IRE and evaluation were extracted.ResultsOf 2602 screened studies, 36 could be included, regarding IRE in liver (n = 24), pancreas (n = 4), blood vessels (n = 4) and nerves (n = 4) in over 440 animals (pig, rat, goat and rabbit). No eligible human studies were found. In liver and pancreas, the first signs of apoptosis and haemorrhage were observed 1–2 hours after treatment, and remained visible until 24 hours in liver and 7 days in pancreas after which the damaged tissue was replaced by fibrosis. In solitary blood vessels, the tunica media, intima and lumen remained unchanged for 24 hours. After 7 days, inflammation, fibrosis and loss of smooth muscle cells were demonstrated, which persisted until 35 days. In nerves, the median time until demonstrable histological changes was 7 days.ConclusionsTissue damage after IRE is a dynamic process with remarkable time differences between tissues in animals. Whereas pancreas and liver showed the first damages after 1–2 hours, this took 24 hours in blood vessels and 7 days in nerves.

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Section: Discussionmentioning

confidence: 99%

“…This might be explained by a different histopathological response of healthy and pathological tissue[55]. In contrast to healthy tissue, pathological tissue may be less capable of regeneration, explaining the longer duration of necrosis reported by Cheng and colleagues[54]. …”

Section: Discussionmentioning

confidence: 99%

Time-Dependent Impact of Irreversible Electroporation on Pancreas, Liver, Blood Vessels and Nerves: A Systematic Review of Experimental Studies

et al. 2016

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“…IRE should have a potential role in patients in waitlist, but currently there are few data about his use as bridging therapy. Cheng et al report a high rate of complete necrosis for IRE used in the treatment of tumor <3 cm (24).…”

Section: Irreversible Electroporation (Ire)mentioning

confidence: 99%

Bridging patients with hepatocellular cancer waiting for liver transplant: all the patients are the same?

Coletta

Nicolini

Cacciaguerra

et al. 2017

Transl. Gastroenterol. Hepatol.

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Hepatocellular carcinoma (HCC) is the fifth more frequent cancer worldwide and the most common primary liver tumor. Liver transplant (LT) is considered the best curative treatment for patients with cirrhosis and HCC within Milan criteria (1 tumor ≤5 cm and up to 3 tumors ≤3 cm). It removes all the liver affected by cancer and at the same time it treats the underlying liver disease, with a survival rate of 70% and a 5 years recurrence rate of less than 20%. Unfortunately, the applicability of LT for HCC patients is limited by the shortage of liver grafts, determining a longer time on waitlist and high dropout rate. Bridging treatments are neo-adjuvant antitumoral therapies given to patients on the waitlist for LT, affected by HCC within the criteria, with the aim to reduce the disease progression and therefore the dropout rate. Indeed, these treatments act as a "bridge" until a suitable donor organ becomes available. Most of bridging therapies are locoregional treatments (LRTs). Dropout rate for HCC progression increases in a time-dependent way (1) and evidences show higher dropout rates in patients with tumor >3 cm and an expected waiting time longer than 3-6 months (2). In different reports, if HCC is left untreated, the risk of drop out at 6 months and at 1 year has been estimated to be respectively 12% and 15-30% (3,4). Risk factors for dropout include: tumor diameter greater than 3 cm or multifocal disease, serum α-fetoprotein (AFP) level greater than 200 ng/mL, waiting time longer than 6 months and lack of response to bridging therapy (5). Although there are no randomized control trials (RCT) evaluating the efficacy of neo-adjuvant therapies in reducing dropout rate and improving survival after LT, LRT is accepted as the standard of care for patients expected to stay on the waitlist for more than 6 months. In patients with HCC within Milan criteria, bridging therapy is estimated to reduce dropout rate to 0-10%. A retrospective study

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“…It also induced complete cell death up to the margin of large vessels bypassing the heat sink effect seen such as in the RFA (91). Up-to-date, there is not much data regarding the use of IRE as bridging therapy, however complete necrosis was achieved in treatment of the tumor <3 cm by IRE (92). There is a potential role of using IRE in management patients waiting for LT.…”

Section: Irreversible Electroporation (Ire)mentioning

confidence: 99%

Bridging and downstaging therapy in patients suffering from hepatocellular carcinoma waiting on the list of liver transplantation

She¹,

Cheung²

2016

Transl. Gastroenterol. Hepatol.

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Hepatocellular carcinoma (HCC) is a common primary malignancy worldwide especially in the patients with the background of chronic liver disease. Liver transplantation (LT) is the only curative treatment effective for both malignancy as well as the cirrhosis and portal hypertension. Unfortunately, living donor is not always possible and the deceased graft is scarce. Neoadjuvant therapies, therefore, have been developed as a downstaging treatment to try to downstage the tumor within the transplant criteria, or as a bridging therapy to control the tumor growth in patients while waiting in the transplant list. This paper reviewed the common modalities used as bridging and downstaging therapies for patients suffering from HCC before undergoing LT.

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Irreversible Electroporation Can Effectively Ablate Hepatocellular Carcinoma to Complete Pathologic Necrosis

Cited by 54 publications

References 17 publications

Time-Dependent Impact of Irreversible Electroporation on Pancreas, Liver, Blood Vessels and Nerves: A Systematic Review of Experimental Studies

Time-Dependent Impact of Irreversible Electroporation on Pancreas, Liver, Blood Vessels and Nerves: A Systematic Review of Experimental Studies

Bridging patients with hepatocellular cancer waiting for liver transplant: all the patients are the same?

Bridging and downstaging therapy in patients suffering from hepatocellular carcinoma waiting on the list of liver transplantation

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