Irreversible Electroporation for the Ablation of Liver Tumors

Charpentier, Kevin P.

doi:10.1001/2013.jamasurg.100

Cited by 58 publications

(37 citation statements)

References 86 publications

(83 reference statements)

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“…These include electrolysis, ionthoporesis, and electro-osmotic flows. The phenomena of electroporation [8][9][10][11][12][13][14][15] and the phenomena of electrolysis [16][17][18][19][20][21][22][23][24][25] were both used in the past for tissue ablation, each separately. However, in 2 recent articles, we show that various optimized combinations of electrolysis with electroporation can increase the extent and control of tissue ablation over protocols designed for each modality separately.…”

Section: Introductionmentioning

confidence: 99%

Electrolytic Effects During Tissue Ablation by Electroporation

Rubinsky

Guenther

Mikus

et al. 2016

Technol Cancer Res Treat

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Nonthermal irreversible electroporation is a new tissue ablation technique that consists of applying pulsed electric fields across cells to induce cell death by creating permanent defects in the cell membrane. Nonthermal irreversible electroporation is of interest because it allows treatment near sensitive tissue structures such as blood vessels and nerves. Two recent articles report that electrolytic reaction products at electrodes can be combined with electroporation pulses to augment and optimize tissue ablation. Those articles triggered a concern that the results of earlier studies on nonthermal irreversible electroporation may have been tainted by unaccounted for electrolytic effects. The goal of this study was to reexamine previous studies on nonthermal irreversible electroporation in the context of these articles. The study shows that the results from some of the earlier studies on nonthermal irreversible electroporation were affected by unaccounted for electrolysis, in particular the research with cells in cuvettes. It also shows that tissue ablation ascribed in the past to irreversible electroporation is actually caused by at least 3 different cytotoxic effects: irreversible electroporation without electrolysis, irreversible electroporation combined with electrolysis, and reversible electroporation combined with electrolysis. These different mechanisms may affect cell and tissue ablation in different ways, and the effects may depend on various clinical parameters such as the polarity of the electrodes, the charge delivered (voltage, number, and length of pulses), and the distance of the target tissue from the electrodes. Current clinical protocols employ ever-increasing numbers of electroporation pulses to values that are now an order of magnitude larger than those used in our first fundamental nonthermal irreversible electroporation studies in tissues. The different mechanisms of cell death, and the effect of the clinical parameters on the mechanisms may explain discrepancies between results of different clinical studies and should be taken into consideration in the design of optimal electroporation ablation protocols.

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Section: Introductionmentioning

confidence: 99%

Electrolytic Effects During Tissue Ablation by Electroporation

Rubinsky

Guenther

Mikus

et al. 2016

Technol Cancer Res Treat

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“…Ablation between electrode 2 and 5 was not considered essential (distance 3.0 cm) since no tumor tissue was expected in this region used for decades to promote the uptake of chemotherapy into the cell, a process known as electrochemotherapy. Capitalizing on this principle, the addition of systemic chemotherapy immediately after IRE could potentially eradicate marginal reversibly electroporated tumor cells, which would improve treatment effect [15]. This approach warrants further study and may contribute to the multidisciplinary treatment approach of cancer in the near future.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Irreversible Electroporation of Locally Advanced Pancreatic Carcinoma Using the Dorsal Approach: A Case Report

Scheffer

Melenhorst

Vogel

et al. 2014

Cardiovasc Intervent Radiol

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Irreversible electroporation (IRE) is a novel image-guided ablation technique that is increasingly used to treat locally advanced pancreatic carcinoma (LAPC). We describe a 67-year-old male patient with a 5 cm stage III pancreatic tumor who was referred for IRE. Because the ventral approach for electrode placement was considered dangerous due to vicinity of the tumor to collateral vessels and duodenum, the dorsal approach was chosen. Under CT-guidance, six electrodes were advanced in the tumor, approaching paravertebrally alongside the aorta and inferior vena cava. Ablation was performed without complications. This case describes that when ventral electrode placement for pancreatic IRE is impaired, the dorsal approach could be considered alternatively.

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“…However, most of the available data are short-term ones. In one of the initial reviews by Charpentier, IRE was not only found to be safe but also potentially superior to other techniques for lesions abutting major vascular structures [29,30]. In another retrospective review [31], IRE-specific treatment outcomes, rates of recurrence, and complications were evaluated in 28 patients with tumor locations precluding other forms of ablation.…”

Section: Irreversible Electroporationmentioning

confidence: 99%