Irreversible Electroporation Systems for Clinical Use

Bertacchini, Claudio; Margotti, Pier Mauro; Bergamini, Enrico; Ronchetti, Mattia; Cadossi, Ruggero

doi:10.1007/978-3-642-05420-4_12

Cited by 5 publications

(3 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We present here the first study of deep-seated tumor electrochemotherapy based on numerical treatment planning. Namely, electrochemotherapy was, until now only used for superficial and accessible tumor nodules, with an approximately 80% objective response rate [ 1 , 7 , 18 - 22 ]. In this, the first reported clinical case, a deep-seated melanoma metastasis in the thigh of the patient was treated by insertion of long needle electrodes around the tumor.…”

Section: Discussionmentioning

confidence: 99%

Towards treatment planning and treatment of deep-seated solid tumors by electrochemotherapy

et al. 2010

View full text Add to dashboard Cite

BackgroundElectrochemotherapy treats tumors by combining specific chemotherapeutic drugs with an intracellular target and electric pulses, which increases drug uptake into the tumor cells. Electrochemotherapy has been successfully used for treatment of easily accessible superficial tumor nodules. In this paper, we present the first case of deep-seated tumor electrochemotherapy based on numerical treatment planning.MethodsThe aim of our study was to treat a melanoma metastasis in the thigh of a patient. Treatment planning for electrode positioning and electrical pulse parameters was performed for two different electrode configurations: one with four and another with five long needle electrodes. During the procedure, the four electrode treatment plan was adopted and the patient was treated accordingly by electrochemotherapy with bleomycin. The response to treatment was clinically and radiographically evaluated. Due to a partial response of the treated tumor, the metastasis was surgically removed after 2 months and pathological analysis was performed.ResultsA partial response of the tumor to electrochemotherapy was obtained. Histologically, the metastasis showed partial necrosis due to electrochemotherapy, estimated to represent 40-50% of the tumor. Based on the data obtained, we re-evaluated the electrical treatment parameters in order to correlate the treatment plan with the clinical response. Electrode positions in the numerical model were updated according to the actual positions during treatment. We compared the maximum value of the measured electric current with the current predicted by the model and good agreement was obtained. Finally, tumor coverage with an electric field above the reversible threshold was recalculated and determined to be approximately 94%. Therefore, according to the calculations, a small volume of tumor cells remained viable after electrochemotherapy, and these were sufficient for tumor regrowth.ConclusionsIn this, the first reported clinical case, deep-seated melanoma metastasis in the thigh of the patient was treated by electrochemotherapy, according to a treatment plan obtained by numerical modeling and optimization. Although only a partial response was obtained, the presented work demonstrates that treatment of deep-seated tumor nodules by electrochemotherapy is feasible and sets the ground for numerical treatment planning-based electrochemotherapy.Trial registrationEudraCT:2008-008290-54

show abstract

Section: Discussionmentioning

confidence: 99%

Towards treatment planning and treatment of deep-seated solid tumors by electrochemotherapy

et al. 2010

View full text Add to dashboard Cite

show abstract

“…The pulses are delivered in synchrony with the patient’s heartbeat to minimize adverse cardiac events or at a frequency of 0.1 to 5 Hz. 14 – 16 However, this protocol can evoke muscle contractions during the pulse delivery process, which may cause pain to the patients and bring about a displacement of the electrodes, thereby adversely affecting the ablation outcome. 9 , 17 Therefore, a deep neuromuscular blockade is necessary to ensure that the IRE treatment goes smoothly.…”

Section: Introductionmentioning

confidence: 99%

First Human Trial of High-Frequency Irreversible Electroporation Therapy for Prostate Cancer

Dong

Wang

Zhao

et al. 2018

Technol Cancer Res Treat

View full text Add to dashboard Cite

Irreversible electroporation, as a nonthermal therapy of prostate cancer, has been used in clinic for several years. The mechanism of irreversible electroporation ablation is thermal independent; thus, the main structures (eg, rectum, urethra, and neurovascular bundle) in prostate are spared during the treatment, which leads to the retention of prostate function. However, various clinical trials have shown that muscle contractions occur during this therapy, which warrants deep muscle anesthesia. Use of high-frequency bipolar pulses has been proposed to reduce muscle contractions during treatment, which has already triggered a multitude of studies at the cellular and animal scale. In this study, we first investigated the efficacy and safety of high-frequency bipolar pulses in human prostate cancer ablation. There are 40 male patients with prostate cancer aged between 51 and 85 years involved in this study. All patients received 250 high-frequency bipolar pulse bursts with the repeat frequency of 1 Hz. Each burst comprised 20 individual pulses of 5 microseconds, so one burst total energized time was 100 microseconds. The number of the electrodes ranged 2 to 6, depending on tumor size. A small amount of muscle relaxant was still needed, so there were no visible muscle contractions during the pulse delivery process. Four weeks after treatment, it was found that the ablation margins were distinct in magnetic resonance imaging scans, and the prostate capsule and urethra were retained. Eight patients underwent radical prostatectomy for pathological analysis after treatment, and the results of hematoxylin and eosin staining revealed that the urethra and major vasculature in prostate have been preserved. By overlaying the electric field contour on the ablation zone, the electric field lethality threshold is determined to be 522 ± 74 V/cm. This study is the first to validate the feasibility of tumor ablation by high-frequency bipolar pulses and provide valuable experience of irreversible electroporation in clinical applications.

show abstract

“…In essence, these systems are based on slowly charging at high voltage a capacitor and then partially discharging it, in a controlled manner, through the electrodes and the tissues. [44] Defibrillators have been the mainstay IRE generators in studies of cardiac ablation. It must be noted, however, that defibrillators are not optimized for IRE.…”

Section: A N U S C R I P Tmentioning

confidence: 99%

Irreversible electroporation for the treatment of cardiac arrhythmias

Sugrue

Maor

Ivorra

et al. 2018

Expert Review of Cardiovascular Therapy

View full text Add to dashboard Cite

Cardiac ablation is an established treatment modality for the management of patients with cardiac arrhythmias. Current approaches to cardiac ablation employ thermal based energy to achieve lesions (damage) within the heart. There are many shortcomings and limitations of thermal based approaches. Electroporation (DC energy) is a non-thermal alternative approach to ablation that has shown significant promise in animal studies. Areas covered: An extensive review of the literature on the application of electroporation for ablation (both cardiac and collateral cardiac tissue) was undertaken. This review explores irreversible electroporation as a cardiac ablation modality. Specifically, it focuses and explains the biophysics of electroporation, the limitations of current thermal based approaches and examines the current data published on electroporation cardiac ablation. Expert commentary: Electroporation is a fast-growing novel ablation modality that has many advantages over current thermal based approaches. Current research in animal models shows its can be safely and efficaciously applied to the heart. Although further research is required, electroporation represents an appealing option for the ablation cardiac arrhythmias.

show abstract

Irreversible Electroporation Systems for Clinical Use

Cited by 5 publications

References 13 publications

Towards treatment planning and treatment of deep-seated solid tumors by electrochemotherapy

Towards treatment planning and treatment of deep-seated solid tumors by electrochemotherapy

First Human Trial of High-Frequency Irreversible Electroporation Therapy for Prostate Cancer

Irreversible electroporation for the treatment of cardiac arrhythmias

Contact Info

Product

Resources

About