Irreversible Electroporation Therapy in the Management of Locally Advanced Pancreatic Adenocarcinoma

Martin, Robert C.G.; McFarland, Kelli; Ellis, Susan; Velanovich, Vic

doi:10.1016/j.jamcollsurg.2012.05.021

Cited by 244 publications

(166 citation statements)

References 61 publications

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“…Interest in IRE clinical application is increasing, especially for use in locations where thermal damage is a substantial concern, such as the pancreas (3,4) or near vital structures such as the bile ducts in the liver (2). Given that it is less sensitive to inherent tissue characteristics such as vascular heat-sink effects that limit the efficacy of thermal ablation modalities that use radiofrequency, microwave, or cryotherapy (5-7), IRE holds promise for effective treatment of tumors adjacent to blood vessels (8).…”

Section: Animal Modelmentioning

confidence: 99%

Irreversible Electroporation: Treatment Effect is Susceptible to Local Environment and Tissue Properties

Ben-David¹,

Ahmed²,

Faroja³

et al. 2013

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).q RSNA, 2013 Purpose:To study the effects of the surrounding electrical microenvironment and local tissue parameters on the electrical parameters and outcome of irreversible electroporation (IRE) ablation in porcine muscle, kidney, and liver tissue. Materials and Methods:Animal Care and Use Committee approval was obtained, and National Institutes of Health guidelines were followed. IRE ablation (n = 90) was applied in muscle (n = 44), kidney (n = 28), and liver (n = 18) tissue in 18 pigs. Two electrodes with tip exposure of 1.5-2 cm were used at varying voltages (1500-3000 V), pulse repetitions (n = 70-100), pulse length (70-100 µsec), and electrode spacing (1.5-2 cm). In muscle tissue, electrodes were placed exactly parallel, in plane, or perpendicular to paraspinal muscle fibers; in kidney tissue, in the cortex or adjacent to the renal medulla; and in liver tissue, with and without metallic or plastic plates placed 1-2 cm from electrodes. Ablation zones were determined at gross pathologic (90-120 minutes after IRE) and immunohistopathologic examination (6 hours after) for apoptosis and heat-shock protein markers. Multivariate analysis of variance with multiple comparisons and/or paired t tests and regression analysis were used for analysis. Results:Mean (6 standard deviation) ablation zones in muscle were 6.2 cm 6 0.3 3 4.2 cm 6 0.3 for parallel electrodes and 4.2 cm 6 0.8 3 3.0 cm 6 0.5 for in-plane application. Perpendicular orientation resulted in a cross-shaped zone. Orientation significantly affected IRE current applied (28.5-31.7A for parallel, 29.5-39.7A for perpendicular; P = .003). For kidney cortex, ovoid zones of 1.5 cm 6 0.1 3 0.5 cm 6 0.0 to 2.5 cm 6 0.1 3 1.3 cm 6 0.1 were seen. Placement of electrodes less than 5 mm from the medullary pyramids resulted in treatment effect arcing into the collecting system. For liver tissue, symmetric 2.7 cm 6 0.2 3 1.4 cm 6 0.3 coagulation areas were seen without the metallic plate but asymmetric coagulation was seen with the metallic plate. Conclusion:IRE treatment zones are sensitive to varying electrical conductivity in tissues. Electrode location, orientation, and heterogeneities in local environment must be considered in planning ablation treatment.q RSNA, 2013 Supplemental material: http://radiology.rsna.org/lookup /suppl

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Section: Animal Modelmentioning

confidence: 99%

Irreversible Electroporation: Treatment Effect is Susceptible to Local Environment and Tissue Properties

Ben-David¹,

Ahmed²,

Faroja³

et al. 2013

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“…Heat capacity C p 500 has proven to be effective (24). The results of this simulation, Figure 7, demonstrate a maximum temperature change of about 12°C at the electrode surface, and 2°C in between the electrodes.…”

Section: Ire and H-fire Treatment Planningmentioning

confidence: 81%

“…In addition to the treatment of brain tumors, IRE has been implemented to treat human patients with prostate (21,22), pancreatic (23)(24)(25), liver (26)(27)(28), and kidney (29,30) tumors. Benefits of IRE therapy include elimination of cytotoxic effects, sharp delineation between treated and spared tissue, a nonthermal mechanism of ablation, treatment planning abilities, sparing of nerves and major blood vessels (31,32), and, if desired, it can be used as a combinatorial treatment with CT and/or RT.…”

Section: Irreversible Electroporationmentioning

confidence: 99%

Maximizing Local Access to Therapeutic Deliveries in Glioblastoma. Part III: Irreversible Electroporation and High-Frequency Irreversible Electroporation for the Eradication of Glioblastoma

2017

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Glioblastoma (GBM) is the most common and aggressive primary brain tumor in adults. Approximately 9180 primary GBM tumors are diagnosed in the United States each year, in which median survival is up to 16 months. GBM eludes and resists typical cancer treatments due to the presence of infiltrative cells beyond the solid tumor margin, heterogeneity within the tumor microenvironment, and protection from the blood-brain barrier. Conventional treatments for GBM, such as surgical resection, radiotherapy, and chemotherapy, have shown limited efficacy;IRE and H-FIRE for the Eradication of GBM 374 therefore, alternate treatments are needed. Tumor chemoresistance and its proximity to critical structures make GBM a prime theoretical candidate for nonthermal ablation with irreversible electroporation (IRE) and high-frequency IRE (H-FIRE). IRE and H-FIRE are treatment modalities that utilize pulsed electric fields to permeabilize the cell membrane. Once the electric field magnitude exceeds a tissue-specific lethal threshold, cell death occurs. Benefits of IRE and H-FIRE therapy include, but are not limited to, the elimination of cytotoxic effects, sharp delineation from treated tissue and spared tissue, a nonthermal mechanism of ablation, and sparing of nerves and major blood vessels. Preclinical studies have confirmed the safety and efficacy of IRE and H-FIRE within their experimental scope. In this chapter, studies will be collected and information extrapolated to provide possible treatment regimens for use in high-grade gliomas, specifically in GBM.

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“…Another multicenter clinical trial included 27 patients with locally advanced pancreatic cancer who received IRE either with or without concurrent partial resection (34). All but one patient received surgical IRE, as opposed to the final patient, who underwent percutaneous IRE.…”

Section: Application Of Electroporation To Percutaneous Tumor Ablationmentioning

confidence: 99%

Irreversible electroporation: the evolution of a laboratory technique to be used in interventional oncology

Deipolyi

Golberg

Yarmush

et al. 2014

Diagn Interv Radiol

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Electroporation involves applying electric field pulses to cells, leading to the alteration or destruction of cell membranes. Irreversible electroporation (IRE) creates permanent defects in cell membranes and induces cell death. By directly targeting IRE to tumors, percutaneous nonthermal ablation is possible. The history of IRE, evolution of concepts, theory, biological applications, and clinical data regarding its safety and efficacy are discussed.

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Irreversible Electroporation Therapy in the Management of Locally Advanced Pancreatic Adenocarcinoma

Cited by 244 publications

References 61 publications

Irreversible Electroporation: Treatment Effect is Susceptible to Local Environment and Tissue Properties

Irreversible Electroporation: Treatment Effect is Susceptible to Local Environment and Tissue Properties

Maximizing Local Access to Therapeutic Deliveries in Glioblastoma. Part III: Irreversible Electroporation and High-Frequency Irreversible Electroporation for the Eradication of Glioblastoma

Irreversible electroporation: the evolution of a laboratory technique to be used in interventional oncology

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