Irreversible Electroporation For Liver Tumors: A Review Of Literature

Abstract

The prevalence of liver tumors is increasing worldwide. These can be broadly classified into primary and secondary types, depending upon the origin of the tumor. Multiple modalities are available for the management of these tumors. Ablative techniques are becoming the cornerstone of management especially for the tumors which are unresectable. Thermal ablative techniques include radiofrequency ablation (RFA), microwave ablation (MWA), and cryotherapy. Recently, a non-thermal technique known as irreversible electroporation (IRE) is gaining importance owing to its better clinical outcome and a good safety profile. IRE works by high voltage and intensity electrical discharge which makes pores in the membrane of the cells. Its clinical outcome is reported in different studies in terms of progression-free survival (PFS), frequency of complete ablation, and local recurrence of the tumor. Favorable results were seen especially for the small size tumors and very early hepatocellular carcinoma (HCC). It was also found to be useful for the management of tumors which are close to vital structures of the liver. The adverse effects of IRE are also comparable to other ablative techniques like RFA and MWA. The common complications associated with this procedure include liver abscess, bleeding, renal failure, pleural effusion, fever, and partial portal vein thrombosis. In view of this literature review, IRE is found to be a good alternative for the management of liver tumor in patients who cannot undergo surgery, thermal ablative procedures or tumor lying close to vital structures. The safety profile of this procedure is also encouraging. Further studies and clinical trials need to be done to explore this technique.

Needle tract seeding following percutaneous irreversible electroporation for hepatocellular carcinoma

“…It has been reported to particularly mitigate the risk of bile duct strictures and biliary fistula formation, which have been reported following use of thermal ablative techniques near biliary strictures 3 9. IRE is considered particularly efficacious as an intervention for small liver tumours (≤4 cm in diameter) 11. Reviews of small retrospective series have reported IRE producing complete responses in up to 90% of tumours and partial responses in 10% of tumours 10 11…”

Local Treatments in the Unresectable Patient with Colorectal Cancer Metastasis: A Review from the Point of View of the Medical Oncologist

“…It is important to note that modern devices are synchronized to the electrocardiogram (ECG) of the patient to deliver pulses in the refractory period of the cardiac contraction to avoid this complication. Other potential complications are hepatic abscesses, pneumothorax, bleeding, portal vein thrombosis and bile duct leakage or occlusion [ 124 , 126 ]. Needle tract seeding following IRE was also described [ 127 ].…”

Novel platinum bipolar electrode for irreversible electroporation in prostate cancer: preclinical study in the beagle prostate

“…IRE is a modality in which high electric field strength is focused to ablate prostate tissues. The electric fields between two monopolar electrodes inserted into tissues cause tissue ablation, including the generation of irreversible nano-sized pores on the surfaces of cell membranes 9 . These irreversible pores cause cells to undergo either catabolic or anabolic apoptosis, followed by necrosis 10 .…”

“…Unlike other focal therapies, this property of IRE can preserve blood vessels and neurons surrounding cells, killing only the involved cells. Thus, one important advantage of IRE is the rapid recovery from injury 9 , 11 , 12 . Because the prostate is located far from the heart, IRE can be used to ablate prostate cancer tissues, while avoiding its heart-associated drawbacks, including muscle contraction and arrhythmia 12 .…”