Patient-specific treatment planning of electrochemotherapy: Procedure design and possible pitfalls

Pavliha, Denis; Kos, Bor; Županič, Anže; Marčan, Marija; Serša, Gregor; Miklavčič, Damijan

doi:10.1016/j.bioelechem.2012.01.007

Cited by 66 publications

(45 citation statements)

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“…Because a well-defined target (i.e., tumor or other pathological tissue) needs to be determined when planning electroporation-based treatments (such as ECT or N-TIRE) of deep-seated tumors (Pavliha et al 2012) and distribution of the electric field in biological tissue is the most important predictor of electroporation (Miklavčič et al 1998(Miklavčič et al , 2006, clinicians and eventually patients can greatly benefit from the Web-based treatment-planning software we have developed. Namely, the software allows generation of electroporation-based treatment plans without prior engineering knowledge and generates 3D models based on patient images that are used for calculation and optimization of the electric field distribution during electroporation.…”

Section: Resultsmentioning

confidence: 99%

“…Since in radiotherapy, a well-established treatment plan we followed (Pavliha et al 2012), the clinician is always responsible for final validation of the treatment plan, the validation of image segmentation for electroporation-based treatment planning is an imperative step. Also, use of the treatment-planning software will be introduced in stages: first, we formed a closed group of beta testers who were offered the possibility to evaluate the functioning of our software.…”

Section: Discussionmentioning

confidence: 99%

“…ECT is already used in clinical practice for treating metastases of skin melanoma in more than 100 clinical institutions in Europe ) and has already been introduced to clinical trials for treating deep-seated metastases in the liver (Edhemović et al 2011), brain (AgerholmLarsen et al 2011;Linnert et al 2012;Mahmood and Gehl 2011), bone (Fini et al 2011) and soft tissue (Neal et al 2011). While following standard operating procedures (Mir et al 2006) ensures safe and successful treatment of skin melanoma metastases (Marty et al 2006), patient-specific treatment planning is nevertheless required for ECT of deep-seated tumors (Pavliha et al 2012). Namely, deepseated tumors are very diverse in shape, size and location in the body; and long-needle electrodes are used for treating such tumors; therefore, coverage of the whole target tissue (i.e., tumor) with a sufficiently high electric field (which is a prerequisite for successful ECT) (Miklavčič et al 1998(Miklavčič et al , 2006 can currently only be assured by means of numerical modeling of electric field distribution.…”

Section: Introductionmentioning

confidence: 99%

“…Patient-specific treatment planning of electroporationbased treatments such as ECT and N-TIRE is based on medical images of the patient, which are used to generate a three-dimensional (3D) model of the target tissue (i.e., tumor) and the organ surrounding the target tissue (Pavliha et al 2012). Then, the 3D model is used for calculation of the electric field distribution during the electroporationbased treatment (Ž upanič et al 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, the treatment-planning software should be as automated as possible since without treatment-planning software a clinician (i.e., a medical doctor) may otherwise need about 6 h to manually perform segmentation of a patient (Paulides et al 2010). The advance from treating skin metastases to treating deep-seated tumors would be facilitated by userfriendly treatment-planning software that would allow clinicians to prepare patient-specific treatment plans without the need of an engineer or a medical physicist or specialized engineering knowledge (Pavliha et al 2012). Here, we describe implementation of a treatment-planning tool including developed methods for image segmentation, model building and determination of electroporation as a Web-based application for treatment planning of electroporation-based therapies such as ECT and N-TIRE.…”

Section: Introductionmentioning

confidence: 99%

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Planning of Electroporation-Based Treatments Using Web-Based Treatment-Planning Software

et al. 2013

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Electroporation-based treatment combining high-voltage electric pulses and poorly permanent cytotoxic drugs, i.e., electrochemotherapy (ECT), is currently used for treating superficial tumor nodules by following standard operating procedures. Besides ECT, another electroporation-based treatment, nonthermal irreversible electroporation (N-TIRE), is also efficient at ablating deepseated tumors. To perform ECT or N-TIRE of deep-seated tumors, following standard operating procedures is not sufficient and patient-specific treatment planning is required for successful treatment. Treatment planning is required because of the use of individual long-needle electrodes and the diverse shape, size and location of deepseated tumors. Many institutions that already perform ECT of superficial metastases could benefit from treatmentplanning software that would enable the preparation of patient-specific treatment plans. To this end, we have developed a Web-based treatment-planning software for planning electroporation-based treatments that does not require prior engineering knowledge from the user (e.g., the clinician). The software includes algorithms for automatic tissue segmentation and, after segmentation, generation of a 3D model of the tissue. The procedure allows the user to define how the electrodes will be inserted. Finally, electric field distribution is computed, the position of electrodes and the voltage to be applied are optimized using the 3D model and a downloadable treatment plan is made available to the user.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Planning of Electroporation-Based Treatments Using Web-Based Treatment-Planning Software

et al. 2013

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Variation in dielectric properties due to pathological changes in human liver

Peyman

Kos

Djokić

et al. 2015

Bioelectromagnetics

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Dielectric properties of freshly excised human liver tissues (in vitro) with several pathological conditions including cancer were obtained in frequency range 100 MHz-5 GHz. Differences in dielectric behavior of normal and pathological tissues at microwave frequencies are discussed based on histological information for each tissue. Data presented are useful for many medical applications, in particular nanosecond pulsed electroporation techniques. Knowledge of dielectric properties is vital for mathematical calculations of local electric field distribution inside electroporated tissues and can be used to optimize the process of electroporation for treatment planning procedures.

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Intraoperative electrochemotherapy of colorectal liver metastases

Edhemović

Brecelj

Gašljević

et al. 2014

Journal of Surgical Oncology

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164

162

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Background and Objectives: Electrochemotherapy is effective in treatment of various cutaneous tumors and could be translated into treatment of deep-seated tumors. With this aim a prospective pilot study was conducted to evaluate feasibility, safety, and efficacy of intraoperative electrochemotherapy in the treatment of colorectal liver metastases. Methods: Electrochemotherapy with bleomycin was performed during open surgery, by insertion of long needle electrodes into and around the tumor according to the individualized pretreatment plan. Results: A 29 metastases in 16 patients were treated in 16 electrochemotherapy sessions. No immediate (intraoperative) and/or postoperative serious adverse events related to electrochemotherapy were observed. Radiological evaluation of all the treated metastases showed 85% complete responses and 15% partial responses. In a group of seven patients that underwent a second operation at 6-12 weeks after the first one, during which electrochemotherapy was performed, the histology of resected metastases treated by electrochemotherapy showed less viable tissue (P ¼ 0.001) compared to non-treated ones. Conclusions: Electrochemotherapy of colorectal liver metastases proved to be feasible, safe, and efficient treatment modality, providing its specific place in difficult to treat metastases, located in the vicinity of major hepatic vessels, not amenable to surgery or radiofrequency ablation.

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Patient-specific treatment planning of electrochemotherapy: Procedure design and possible pitfalls

Cited by 66 publications

References 66 publications

Planning of Electroporation-Based Treatments Using Web-Based Treatment-Planning Software

Planning of Electroporation-Based Treatments Using Web-Based Treatment-Planning Software

Variation in dielectric properties due to pathological changes in human liver

Intraoperative electrochemotherapy of colorectal liver metastases

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